Wikipedia map_bmswiki https://map-bms.wikipedia.org/wiki/Kaca_Utama MediaWiki 1.46.0-wmf.24 first-letter Médhia Mirunggan Parembugan Naraguna Parembugan Naraguna Wikipedia Parembugan Wikipedia Barkas Parembugan Barkas MédhiaWiki Parembugan MédhiaWiki Cithakan Parembugan Cithakan Pitulung Parembugan Pitulung Kategori Parembugan Kategori TimedText TimedText talk Modhul Parembugan Modhul Acara Pembicaraan Acara 0 34562 222281 222230 2026-04-19T00:28:38Z InternetArchiveBot 13908 Rescuing 1 sources and tagging 0 as dead.) #IABot (v2.0.9.5 222281 wikitext text/x-wiki {{Infobox Disease |Name=Influenza |Image=EM of influenza virus.jpg |Caption=[[transmisi èlèktron mikroskopik|TEM]] saka [[virus]] influenza, digedhèkaké kurang luwih tikel kaping 100.000. |Width=226 |DiseasesDB=6791 |ICD10={{ICD10|J|10||j|09}}, {{ICD10|J|11||j|09}} |ICD9={{ICD9|487}} |MedlinePlus=000080 |eMedicineSubj=med |eMedicineTopic=1170 |eMedicine_mult={{eMedicine2|ped|3006}} |MeshID=D007251 }} '''Influenza''', kang luwih ditepungi kanthi sebutan flu, wujud [[lelara nular]] kang disebabaké déning [[Virus#Virus RNA|virus RNA]] saka [[famili]] [[Orthomyxoviridae]] (virus influenza), kang nyerang [[unggas]] lan [[mamalia]]. Tandha-tandha kang paling umum saka lelara iki ya iku ndredheg, mriyang, perih tenggorokane, perih otot, sirah abot, [[watuk]], lemes, lan [[malaise]].<ref name=Merck>{{cite web |url=http://www.merck.com/mmhe/sec17/ch198/ch198d.html |title=Influenza: Viral Infections: Merck Manual Home Edition |publisher=www.merck.com |accessdate=2008-03-15 |last= |first= }} </ref> Sanajan asring kijolan karo lelara mèmper influenza liyané, mligi [[selesma]], influenza wujud lelara kang luwih abot tinimbang selesma lan disababaké déning jinis virus kang béda<ref name=Eccles>{{cite journal |last=Eccles |first=R |title=Understanding the symptoms of the common cold and influenza |journal=Lancet Infect Dis |volume=5 |issue=11 |pages=718–25 |year=2005 |pmid=16253889 |doi=10.1016/S1473-3099(05)70270-X}}</ref> Influenza bisa nimbulaké eneg, lan muntah, mligi ing bocah-bocah,<ref name=Merck/> nanging tandha-tandha mau luwih asring ana ing lelara [[gastroenteritis]], kang babar pisan ora ana gegandhèngané, kang uga sok-sok kanthi ora trep diarani "flu weteng".<ref>[https://web.archive.org/web/20110707074827/http://coldflu.about.com/od/flumisconceptions/f/stomachflu.htm Seasonal Flu vs. Stomach Flu] by Kristina Duda, R.N.; Diakses 12 Maret 2007 (Website: "About, Inc., A part of The New York Times Company"). So-called "stomach flu" is sometimes also called "24-hour flu." Neither one is actually flu and are instead unrelated [[gastroenteritis]].</ref> Flu sok-sok bisa nimbulaké pneumonia viral kanthi langsung uga nimbulaké pneumonia bakterial sékundhèr.<ref name="Ballinger-2010">{{Cite journal | last1 = Ballinger | first1 = MN. | last2 = Standiford | first2 = TJ. | title = Postinfluenza bacterial pneumonia: host defenses gone awry. | journal = J Interferon Cytokine Res | volume = 30 | issue = 9 | pages = 643-52 | month = Sep | year = 2010 | doi = 10.1089/jir.2010.0049 | PMID = 20726789 }}</ref> Lumrahé, influenza ditularaké liwat udara liwat watuk utawa wahing, kang bakal nimbulaké ''[[aerosol]]'' kang ngandhut virus. Influenza uga bisa ditularaké liwat kontak langsung karo tai manuk utawa [[umbel]], utawa liwat kontak karo lumahan kang wis kena kontaminasi. Aerosol kang kagawa déning udara (airborne aerosols) dinuga nimbulaké sapérangan gedhé infèksi, sanajan jalur panularan endi kang paling duwé peran sajeroning lelara iki durung cetha temenan.<ref name=Brankston/> Virus influenza bisa diinaktivasi déning sinar [[srengéngé]], [[disinfektan]], lan [[deterjen]].<ref>{{cite journal |last=Suarez |first=D |coauthors=Spackman E, Senne D, Bulaga L, Welsch A, Froberg K |title=The effect of various disinfectants on detection of avian influenza virus by real time RT-PCR |journal=Avian Dis |volume=47 |issue=3 Suppl |pages=1091–5 |year=2003 |pmid=14575118 |doi=10.1637/0005-2086-47.s3.1091}}</ref><ref>[http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/biofacts/avflu_human.html Avian Influenza (Bird Flu)]: Implications for [[Disease|Human Disease]]. Physical characteristics of influenza A viruses. UMN CIDRAP.</ref> Asring ngumbah tangan bakal ngurangi risiko infèksi amarga virus bisa diinaktivasi karo sabun.<ref name="Jefferson-2010">{{Cite journal | last1 = Jefferson | first1 = T. | last2 = Del Mar | first2 = C. | last3 = Dooley | first3 = L. | last4 = Ferroni | first4 = E. | last5 = Al-Ansary | first5 = LA. | last6 = Bawazeer | first6 = GA. | last7 = van Driel | first7 = ML. | last8 = Nair | first8 = S. | last9 = Foxlee | first9 = R. | title = Physical interventions to interrupt or reduce the spread of respiratory viruses. | journal = Cochrane Database Syst Rev | volume = | issue = 1 | pages = CD006207 | month = | year = 2010 | doi = 10.1002/14651858.CD006207.pub3 | PMID = 20091588 }}</ref> Influenza nyebar menyang saindhenging donya sajeroning [[epidemi]] mangsan, kang nimbulaké pepati 250.000 lan 500.000 wong saben tauné,<ref>[http://www.who.int/mediacentre/factsheets/fs211/en/ Influenza (Seasonal)], [[World Health Organization]], April 2009. Diaksès 13-02-2010.</ref> malah nganti mayuta-yuta wong ing sapérangan taun pandemik. Rata-rata 41.400 wong mati saben tauné ing [[Amérikah Sarékat]] sajeroning kurun wektu antara taun 1979 tekan 2001 amarga influenza.<ref>{{cite journal |url=http://aje.oxfordjournals.org/cgi/content/full/163/2/181 |title=Mortality due to Influenza in the United States — An Annualized Regression Approach Using Multiple-Cause Mortality Data | author=[[Jonathan Dushoff]] | journal =[[American Journal of Epidemiology]] | volume = 163| issue = 2| pages = 181–7|accessdate=2009-10-29 |quote=The regression modhèl attributes an annual average of 41,400 (95% confidence interval: 27,100, 55,700) deaths to influenza over the period 1979–2001. |work= |pmid=16319291 |doi=10.1093/aje/kwj024 |year=2006 |first2=JB |first3=C |first4=DJ |first5=L |last2=Plotkin |last3=Viboud |last4=Earn |last5=Simonsen }}</ref> Nalika taun 2010 [[Pusat Pangendhalian lan Panyegahan Lelara]] ing Amérikah Sarékat ngowahi carané nglapuraké prakiran pepati amarga influenza sajeroning 30 taun. Saiki Pusat Pangendhalian lan Panyegahan Lelara nglapuraké yèn ana kisaran angka pepati wiwit saka 3.300 nganti 49.000 pepati per tauné.<ref>{{cite news |author=[[Julie Steenhuysen]] |coauthors= |title=CDC backs away from decades-old flu death estimate |url=http://www.reuters.com/article/idUSTRE67P3NA20100826 |quote=Instead of the estimated 36,000 annual flu deaths in the United States... the actual number in the past 30 years has ranged from a low of about 3,300 deaths to a high of nearly 49,000, the CDC said on Thursday. |work=[[Reuters]] |date=August 26, 2010 |accessdate=2010-09-13 }}</ref> Telu pandemi influenza dumadi nalika abad karongpuluh lan wis niwasaké puluhan yuta wong. Saben pandemi mau disababaké déning munculé galur anyar [[virus]] iki ing manungsa. Asring uga, [[galur]] anyar iki muncul nalika virus flu kang wis ana nyebar ing manungsa saka [[spésies]] kéwan kang liya, utawa nalika galur virus influenza manungsa kang wis ana njupuk [[gen]] anyar saka virus kang lumrahé nginfèksi unggas utawa babi. Galur unggas kang diarani [[H5N1]] wis nimbulaké kakuwatiran munculé pandemi influenza anyar, sawisé kamunculané ing [[Asia]] nalika taun 1990-an, nanging virus mau durung [[évolusi]] dadi wangun kang nyebar kanthi gampang saka manungsa-menyang-manungsa.<ref>{{cite web |title=Avian influenza ("bird flu") fact sheet |url=http://www.who.int/mediacentre/factsheets/avian_influenza/en/ |month=February | year=2006 |publisher=WHO |accessdate=2006-10-20}}</ref> Nalika sasi April 2009 sawijining galur virus flu anyar ngalami évolusi kang ngandhut campuran gen saka flu [[manungsa]], [[babi]], lan [[unggas]], kang ing awalé diarani "[[flu babi]]" lan uga ditepungi minangka [[Virus H1N1|influenza A/H1N1]], kang muncul ing [[Mèksiko]], [[Amérikah Sarékat]], lan sapérangan nagara liya. [[Organisasi Kaséhatan Donya]] (WHO) kanthi resmi ndhéklarasikaké wabah iki minangka pandemi nalika tanggal 11 Juni 2009 (delengen [[Wabah flu babi 2009|pandemi flu 2009]]). Dhéklarasi WHO ngenani pandemi tingkat 6 wujud indhikasi panyebaran virus, dudu abot-ènthèngé lelara, galur iki sajatiné duwé tingkat mortalitas kang luwih asor tinimbang wabah virus flu biyasa.<ref>World Health Organization. World now at the start of 2009 influenza pandemic. http://www.who.int/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/en/index.html</ref> [[Vaksin influenza|Vaksinasi marang influenza]] lumrahé sumadiya kanggo wong-wong ing [[nagara ngrembaka]].<ref name=WHOvaccines>[http://www.who.int/wer/2005/wer8033.pdf WHO position paper: influenza vaccines] ''WHO weekly Epidemiological Record'' 19 August 2005, vol. 80, 33, hal. 277–288.</ref> Kéwan ingon unggas asring divaksinasi kanggo nyegah tumpes tapisé kabèh kéwan ingon.<ref>{{cite journal |last=Villegas |first=P |title=Viral diseases of the respiratory system |journal=Poult Sci |volume=77 |issue=8 |pages=1143–5 |year=1998 |pmid=9706079}}</ref> Vaksin kanggo manungsa kang paling asring dipigunakaké ya iku vaksin influenza trivalen (''trivalent influenza vaccine'' [TIV]) kang ngandhut [[antigen]] kang wis dimurnèkaké lan diinaktivasi marang telung galur virus. Lumrahé, vaksin jinis iki ngandhut matérial saka rong galur [[virus influenza A|virus influenza subtipe A]] lan [[virus influenza B|siji galur influenza subtipe B]].<ref>{{cite journal |author=Horwood F, Macfarlane J |title=Pneumococcal and influenza vaccination: current situation and future prospects |journal=Thorax |volume=57 |issue=Suppl 2 |pages=II24–II30 |year=2002 |month=October |pmid=12364707 |pmc=1766003 |url=http://thorax.bmj.com/cgi/pmidlookup?view=long&pmid=12364707}}</ref> TIV ora duwé risiko nularaké lelara, lan duwé réaktivitas kang asor banget. Vaksin kang diformulasikaké kanggo setaun mungkin dadi ora èfèktif kanggo taun sabanjuré, amarga virus influenza ngalami évolusi kanthi rikat, lan galur anyar bakal rikat nggantèkaké galur kang sadurungé. Obat-obatan antivirus bisa dipigunakaké kanggo nambani influenza, ''[[neuraminidase inhibitor]]'' (kaya ta Tamiflu utawa Relenza).<ref name=WHOmedrecDec2009>World Health Organization, Global Alert and Response (GAR), [http://www.who.int/csr/disease/swineflu/frequently_asked_questions/antivirals/definitions_use/en/index.html Antiviral drugs for pandemic (H1N1) 2009: definitions and use], 22 Dhésèmber 2009.</ref> <!--yang terutama efektif-->. == Klasifikasi == {{Flu}} === Jinis-jinis virus === Sajeroning [[Virus#Klasifikasi virus|klasifikasi virus]], virus influenza kalebu [[Virus#Virus RNA|virus RNA]] kang wujud telu saka lima [[genera]] sajeroning famili Oethomyxoviridae:<ref name=Kawaoka>{{cite book |author=Kawaoka Y (juru besut). |title=Influenza Virology: Current Topics |publisher=Caister Academic Press |year=2006 |url=http://www.horizonpress.com/flu |isbn=978-1-904455-06-6}}</ref> * [[Virus influenza A]] * [[Virus influenza B]] * [[Virus influenza C]] Virus-virus mau duwé kakerabatan kang adoh karo [[virus parainfluenza manungsa]], kang wujud virus RNA kang wujud péranganing famili [[Paramyxoviridae#Paramyxovirus|paramyxovirus]] kang wujud jalaran umum saka infèksi [[sistem ambegan|ambegan]] ing bocah, kaya ta [[croup]] (laryngotracheobronchitis),<ref>{{cite journal |author=Vainionpää R, Hyypiä T |title=Biology of parainfluenza viruses |journal=Clin. Microbiol. Rev. |volume=7 |issue=2 |pages=265–75 |year=1994 |month=April |pmid=8055470 |pmc=358320 |url=http://cmr.asm.org/cgi/pmidlookup?view=long&pmid=8055470}}</ref> nanging bisa uga nimbulaké lelara kang sarupa karo influenza ing wong diwasa.<ref>{{cite journal |author=Hall CB |title=Respiratory syncytial virus and parainfluenza virus |journal=N. Engl. J. Med. |volume=344 |issue=25 |pages=1917–28 |year=2001 |month=June |pmid=11419430 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=11419430&promo=ONFLNS19 |doi=10.1056/NEJM200106213442507}}</ref> ==== Virus influenza A ==== Genus iki duwé siji spésies, virus influenza A. Unggas akuatik alasan wujud inang alamiah kanggo pérangan gedhé variétas influenza A. Sok-sok, virus bisa ditularaké marang spésies liya lan bisa nimbulaké wabah kang duwé dhampak gedhé ing paternakan unggas dhomèstik utawa nimbulaké sawijining [[pandemi]] influenza manungsa.<ref name=sobrino6>{{cite book |chapterurl=http://www.horizonpress.com/avir|author=Klenk ''et al.''|year=2008|chapter=Avian Influenza: Molecular Mechanisms of Pathogenesis and Host Range|title=Animal Viruses: Molecular Biology|publisher=Caister Academic Press|isbn=978-1-904455-22-6}}</ref> Virus jinis A wujud patogèn manungsa paling virulen ing antarané katelu jinis influenza lan nimbulaké lelara kang paling abot. Virus influenza A bisa dipérang manèh dadi subdhivisi wujud [[serovar|serotipe-serotipe]] kang béda dhedhasar tanggepan [[antibodi]] marang virus iki.<ref name=hay/> Serotipe kang wis dikonfirmasi ing manungsa, diurutaké dhedhasar guènggung pepati pandemi ing manungsa, ya iku: * [[H1N1]], kang nimbulaké [[Flu Spanyol]] nalika taun 1918, lan [[Flu Babi]] nalika taun 2009 * [[H2N2]], kang nimbulaké [[Flu Asia]] nalika taun 1957 * [[H3N2]], kang nimbulaké [[Flu Hongkong]] nalika taun 1968 * [[H5N1]], kang nimbulaké [[Flu Manuk]] nalika taun 2004 * [[H7N7]], kang duwé potènsi [[zoanatik]] kang ora biyasa<ref>{{cite journal |last=Fouchier |first=R |coauthors=Schneeberger P, Rozendaal F, Broekman J, Kemink S, Munster V, Kuiken T, Rimmelzwaan G, Schutten M, Van Doornum G, Koch G, Bosman A, Koopmans M, Osterhaus A |title=Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of acute respiratory distress syndrome |url=http://www.pnas.org/cgi/content/full/101/5/1356 |journal=Proc Natl Acad Sci USA |volume=101 |issue=5 |pages=1356–61 |year=2004 |pmid=14745020 |doi=10.1073/pnas.0308352100 |last12=Bosman |first12=A |last13=Koopmans |first13=M |last14=Osterhaus |first14=AD |pmc=337057}}</ref> * [[H1N2]], endemik ing manungsa, babi, lan unggas * [[H9N2]] * [[H7N2]] * [[H7N3]] * [[H10N7]] ==== Virus influenza B ==== Genus iki duwé siji spésies, ya iku virus influenza B. Influenza B mèh kanthi èksklusif mung nyerang manungsa<ref name=hay>{{cite journal |last=Hay |first=A |coauthors=Gregory V, Douglas A, Lin Y |title=The evolution of human influenza viruses |journal=Philos Trans R Soc Lond B Biol Sci |volume=356 |issue=1416 |pages=1861–70 |year=2001 |month=December 29 |pmid=11779385 |doi=10.1098/rstb.2001.0999 |pmc=1088562}}</ref> lan luwih arang dibandhingaké karo influenza A. Kéwan liya kang dikawruhi bisa kena infèksi déning influenza B ya iku [[asu laut]]<ref>{{cite journal |last=Osterhaus |first=A |coauthors=Rimmelzwaan G, Martina B, Bestebroer T, Fouchier R |title=Influenza B virus in seals |journal=Science |volume=288 |issue=5468 |pages=1051–3 |year=2000 |pmid=10807575 |doi=10.1126/science.288.5468.1051}}</ref> lan [[garangan]].<ref>{{cite journal |author=Jakeman KJ, Tisdale M, Russell S, Leone A, Sweet C |title=Efficacy of 2'-deoxy-2'-fluororibosides against influenza A and B viruses in ferrets |journal=Antimicrob. Agents Chemother. |volume=38 |issue=8 |pages=1864–7 |year=1994 |month=August |pmid=7986023 |pmc=284652 |doi=|url=http://aac.asm.org/cgi/pmidlookup?view=long&pmid=7986023}}</ref> Jinis influenza iki ngalami mutasi kaping 2-3 luwih alon dibandhingaké jinis A<ref>{{cite journal |last=Nobusawa |first=E |coauthors=Sato K |title=Comparison of the mutation rates of human influenza A and B viruses |journal=J Virol |volume=80 |issue=7 |pages=3675–8 |year=2006 |month=April |pmid=16537638 |doi=10.1128/JVI.80.7.3675-3678.2006 |pmc=1440390}}</ref> lan mula saka iku karagaman génétiké luwih sithik, mung ana siji serotipe influenza B.<ref name=hay/> Amarga ora ana karagaman [[antigen]]ik, sapérangan tingkat [[imunitas|kakebalan]] marang influenza B lumrahé dièntuki ing umur enom. Nanging, mutasi kang dumadi ing virus influenza B cukup kanggo gawé kakebalan permanèn dadi ora mungkin.<ref name=webster>{{cite journal |first=Webster |last=R |coauthors=Bean W, Gorman O, Chambers T, Kawaoka Y |title=Evolution and ecology of influenza A viruses |pmc=372859 |journal=Microbiol Rev |volume=56 |issue=1 |pages=152–79 |year=1992 |pmid=1579108}}</ref> Owah-owahan antigèn kang alon, dikombinasikaké karo gunggung inang kang winates (ora mungkinaké [[pepindhahan antigèn]] antarspesies), agawé pandemi influenza B ora dumadi.<ref name=Zambon>{{cite journal |last=Zambon |first=M |title=Epidemiology and pathogenesis of influenza |journal=J Antimicrob Chemother |volume=44 Suppl B |issue=|pages=3–9 |year=1999 |month=November |pmid=10877456 |url=http://jac.oxfordjournals.org/cgi/reprint/44/suppl_2/3 |doi=10.1093/jac/44.suppl_2.3}}</ref> ==== Virus influenza C ==== Genus iki duwé siji spésies, virus influenza C, kang nginfèksi manungsa, asu, lan babi, sok-sok nimbulaké lelara kang abot lan èpidemi lokal.<ref name="Matsuzaki">{{cite journal |last=Matsuzaki |first=Y |coauthors=Sugawara K, Mizuta K, Tsuchiya E, Muraki Y, Hongo S, Suzuki H, Nakamura K |title=Antigenic and genetic characterization of influenza C viruses which caused two outbreaks in Yamagata City, Japan, in 1996 and 1998 |pmc=153379 |journal=J Clin Microbiol |volume=40 |issue=2 |pages=422–9 |year=2002 |pmid=11825952 |doi=10.1128/JCM.40.2.422-429.2002}}</ref><ref name=Taubenberger2008/> Nanging, influenza C luwih arang dumadi dibandhingaké karo jinis liya lan lumrahé mung nimbulaké lelara ènthèng ing bocah-bocah.<ref>{{cite journal |last=Matsuzaki |first=Y |coauthors=Katsushima N, Nagai Y, Shoji M, Itagaki T, Sakamoto M, Kitaoka S, Mizuta K, Nishimura H |title=Clinical features of influenza C virus infection in children |journal=J Infect Dis |volume=193 |issue=9 |pages=1229–35 |year=2006 |month=1 May|pmid=16586359 |doi=10.1086/502973}}</ref><ref name="Katagiri">{{cite journal |last=Katagiri |first=S |coauthors=Ohizumi A, Homma M |title=An outbreak of type C influenza in a children's home |journal=J Infect Dis |volume=148 |issue=1 |pages=51–6 |year=1983 |month=July |pmid=6309999}}</ref> === Struktur, sipat, lan tata jeneng subtipe === Virus influenza A, B, lan C sarupa banget ing struktur sakabèhé.<ref>International Committee on Taxanamy of Viruses descriptions of: [http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/46000000.htm Orthomyxoviridae]{{dead link|date=August 2010}}, [http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/46040000.htm Influenzavirus B]{{dead link|date=August 2010}} and [http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/00.046.0.02.htm Influenzavirus C]{{dead link|date=August 2010}}</ref> Partikel virus iki dhiameteré 80-120 [[nanometer]] lan lumrahé kurang-luwih wanguné kaya bal, sanadyan wangun filamèntosa mungkin waé ana.<ref>{{cite web |author=International Committee on Taxanamy of Viruses |title=The Universal Virus Database, version 4: Influenza A |url=http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/00.046.0.01.htm}}{{dead link|date=August 2010}}</ref><ref name=Lamb>{{cite journal |author=Lamb RA, Choppin PW |title=The gene structure and replication of influenza virus |journal=Annu. Rev. Biochem. |volume=52 |issue=|pages=467–506 |year=1983 |pmid=6351727 |doi=10.1146/annurev.bi.52.070183.002343}}</ref> Wangun filamèntosa iki luwih asring dumadi ing influenza C, kang bisa minangka struktur kaya bolah kanthi dawa tekan 500 [[mikrometer]] ing lumahan saka sèl kang kena infèksi.<ref name=Bouvier/> Nanging, sanadyan manéka wanguné, partikel saka kabèh virus influenza duwé komposisi kang padha.<ref name=Bouvier/> Komposisi mau wujud [[envelope virus]] kang ngandhut loro jinis [[glikoprotein]], kang mbungkus sawijining inti punjer. Inti punjer mau ngandhut [[genom]] [[RNA]] lan protèin viral liya kang mbungkus lan ngreksa RNA. RNA ''cenderung'' kapérang saka sauntaian nanging ing kasus-kasus mirunggan bisa wujud rong untaian.<ref name=Lamb/> Ing virus, génom virus ora kapérang saka rerangkèn [[asem nukleat]]; nanging lumrahé kapérang saka pitu utawa wolung pérangan RNA ''[[negative-sense]]'' kang kasègmèntasi, saben pérangan RNA ngandhut siji utawa loro gèn.<ref name=Bouvier/> Contoné, génom influenza A ngandhut 11 gèn sajeroning wolung pérangan RNA, kang ngodhe 11 [[protèin]]: [[hemagglutinin]] (HA), [[neuraminidase]] (NA), [[nukleoprotein]] (NP), [[protèin M1|M1]], [[protèin M2|M2]], [[protèin NS1 influenza|NS1]], NS2 (NEP: ''nuclear export protéin''), PA, PB1 (''polymerase basic'' 1), PB1-F2 lan PB2.<ref name=Ghedin>{{cite journal |last=Ghedin |first=E | last2 = Sengamalay | first2 = NA | last3 = Shumway | first3 = M | last4 = Zaborsky | first4 = J | last5 = Feldblyum | first5 = T | last6 = Subbu | first6 = V | last7 = Spiro | first7 = DJ | last8 = Sitz | first8 = J | last9 = Koo | first9 = H |title=Large-scale sequencing of human influenza reveals the dynamic nature of viral genome evolution |journal=[[Nature (journal)|Nature]] |volume=437 |issue=7062 |pages=1162–6 |year=2005 |month=October |pmid=16208317 |doi=10.1038/nature04239 }}</ref> Hemagglutinin (HA) lan neuraminidase (NA) wujud loro flikoprotèin gedhé kang ana ing sanjabaning partikel virus. HA wujud [[lektin]] kang dadi mèdhiasi ikatan (binding) virus marang sèl targèt lan mlebuné génom virus ing sèl targèt, sauntara NA kalibat sajeroning uculé anak virus saka sèl kang kainfèksi, kanthi nyigar gula kang silih iket ing partikel virus diwasa.<ref>{{cite journal |last=Suzuki |first=Y |title=Sialobiology of influenza: molecular mechanism of host range variation of influenza viruses |url=http://www.jstage.jst.go.jp/article/bpb/28/3/399/_pdf |journal=Biol Pharm Bull |volume=28 |issue=3 |pages=399–408 |year=2005 |pmid=15744059 |doi=10.1248/bpb.28.399}}</ref> Oleh karena itu, protéin ini merupakan target bagi obat-obat antivirus.<ref name=Itzstein>{{cite journal |last=Wilson |first=J |coauthors=von Itzstein M |title=Recent strategies in the search for new anti-influenza therapies |journal=Curr Drug Targets |volume=4 |issue=5 |pages=389–408 |year=2003 |month=July |pmid=12816348 |doi=10.2174/1389450033491019}}</ref> Lan manèh, kaloroné wujud antigèn, ing endi antibodi marang antigèn mau bisa diriptakaké. Virus influenza A diklasifikasikaké dadi subtipe dhedhasar rèspons antibodi marang HA lan NA. Jinis-jinis HA lan NA mau wujud pambédan H lan N sajeroning pamènèhan jeneng virus, umpamané H5N1.<ref name=Hilleman/> Ana 16 subtipe H lan 9 subtipe N kang wis dikawruhi, nanging mung H 1, 2, lan 3, sarta N 1 lan 2 kang lumrahé tinemu ing manungsa.<ref name=Lynch>{{cite journal |author=Lynch JP, Walsh EE |title=Influenza: evolving strategies in treatment and prevention |journal=Semin Respir Crit Care Med |volume=28 |issue=2 |pages=144–58 |year=2007 |month=April |pmid=17458769 |doi=10.1055/s-2007-976487}}</ref> === Réplikasi === Virus bisa nglakoni réplikasi mung ing sèl urip.<ref>{{cite journal |author=Smith AE, Helenius A |title=How viruses enter animal cells |journal=Science |volume=304 |issue=5668 |pages=237–42 |year=2004 |month=April |pmid=15073366 |doi=10.1126/science.1094823}}</ref> Infèksi lan réplikasi influenza wujud prosès mawa tahap: pisanan, virus kudu gawé ikatan karo sèl lan ngleboni sèl, banjur mindhahaké genomé ing sawijining papan ing endi virus mau bisa mrodhuksi dhuplikat saka protèin virus lan RNA, banjur nyusun komponèn-komponèn mau dadi partikel virus anyar, lan pungkasan, metu saka sèl inang.<ref name=Bouvier>{{cite journal |author=Bouvier NM, [[Peter Palese|Palese P]] |title=The biology of influenza viruses |journal=Vaccine |volume=26 Suppl 4 |pages=D49–53 |year=2008 |month=September |pmid=19230160 |doi=10.1016/j.vaccine.2008.07.039}}</ref> Virus influenza gawé ikatan liwat [[hemagglutinin]] karo gula [[asem sialat]] ing lumahing [[epitelium|sèl èpitèl]], lumrahé ing irung, tenggorok, lan [[paru-paru]] mamalia, lan usus unggas (tahap 1 ing gambar infèksi).<ref name=Wagner>{{cite journal |last=Wagner |first=R |coauthors=Matrosovich M, Klenk H |title=Functional balance between haemagglutinin and neuraminidase in influenza virus infections |journal=Rev Med Virol |volume=12 |issue=3 |pages=159–66 |year=2002 |month=May–June|pmid=11987141 |doi=10.1002/rmv.352}}</ref> Sawisé hemagglutinin [[proteolisis|dipecah]] déning [[protease]], sèl bakal nglebokaké virus liwat prosès [[endositosis]].<ref name=Steinhauer>{{cite journal |author=Steinhauer DA |title=Role of hemagglutinin cleavage for the pathogenicity of influenza virus |journal=Virology |volume=258 |issue=1 |pages=1–20 |year=1999 |month=May |pmid=10329563 |doi=10.1006/viro.1999.9716}}</ref> Sawisé ana ing njero sèl, kaanan asem sajeroning [[éndosom]] bakal njalari loro kedadèn dumadi: pisanan, péranganing protèin hemagglutinin bakal nyawijikaké envelope virus karo mèmbran vakuola, banjur [[kanal ion]] M2 bakal mungkinaké [[proton]] kanggo pindhah ngliwati envelope virus lan ngasamaké inti virus, kang bakal nyababaké inti dadi kaurai lan ngeculaké RNA virus lan protèin inti.<ref name=Bouvier/> Molekul RNA virus (vRNA), protèin aksesoris, lan RNA polymerase kang gumantung ing RNA (RNA-dependent RNA polymerase) bakal dieculaké ing sitoplasma (Tahap 2).<ref>{{cite journal |last=Lakadamyali |first=M |coauthors=Rust M, Babcock H, Zhuang X |title=Visualizing infection of individual influenza viruses |journal=Proc Natl Acad Sci USA |volume=100 |issue=16 |pages=9280–5 |year=2003 |month=August |pmid=12883000 |doi=10.1073/pnas.0832269100 |pmc=170909}}</ref> Kanal ion M2 bakal disekat (diblok) déning obat amantadine, kang bakal nyegah infèksi.<ref name=Pinto>{{cite journal |author=Pinto LH, Lamb RA |title=The M2 proton channels of influenza A and B viruses |journal=J. Biol. Chem. |volume=281 |issue=14 |pages=8997–9000 |year=2006 |month=April |pmid=16407184 |doi=10.1074/jbc.R500020200 |url=http://www.jbc.org/cgi/pmidlookup?view=long&pmid=16407184}}</ref> Protèin inti iki bebarengan karo vRNA bakal minangka komplèks kang bakal ditranspor menyang [[inti sèl]], ing endi polimerase RNA kang gumantung RNA bakal miwiti transkripsi vRNA komplemèntèr sense positif (langkah 3a lan b).<ref>{{cite journal |last=Cros |first=J |coauthors=Palese P |title=Trafficking of viral genomic RNA into and out of the nucleus: influenza, Thogoto and Borna disease viruses |journal=Virus Res |volume=95 |issue=1–2 |pages=3–12 |year=2003 |month=September |pmid=12921991 |doi=10.1016/S0168-1702(03)00159-X}}</ref> vRNA bisa metu nuju sitoplasma lan ngalami translasi (langkah 4) utawa tetep ''bertahan'' ing nukléus. Protèin virus kang anyar disintèsis bisa disèkrèsi liwat [[apparatus Golgi]] nuju lumahing sèl (ing neuraminidase lan hemagglutinin, langkah 5b) utawa ditranspor manèh nuju inti sèl kanggo gawé ikatan karo vRNA lan minangka partikel génom virus kang anyar (langkah 5a). Protèin virus liyané duwé makarya kang manéka ing sèl inang, kalebu ngurai [[mRNA]] sèlulèr lan migunakaké [[nukléotida]] bébas kanggo sintèsis vRNA lan uga nyandhet translasi mRNA lan uga nyandhet [[translasi (biologi)|translasi]] mRNA sèl inang.<ref>{{cite journal |last=Kash |first=J |coauthors=Goodman A, Korth M, Katze M |title=Hijacking of the host-cell response and translational control during influenza virus infection |journal=Virus Res |volume=119 |issue=1 |pages=111–20 |year=2006 |month=July |pmid=16630668 |doi=10.1016/j.virusres.2005.10.013}}</ref> vRNA ''negative-sense'' kang [[génom]] saka calon virus, RNA polimerase kang gumantung RNA (RNA-dependent RNA polymerase), lan protèin virus liya bakal disusun dadi virion. Molekul hemagglutinin lan neuraminidase bakal gawé golongan minangka sawijining tonjolan ing lumahing sèl. vRNA lan protèin [[capsid|inti virus]] bakal ninggal inti sèl lan ngeboni panonjolan mèmbran iki (langkah 6). Virus diwasa bakal nglakokaké budding off saka sèl sajeroning sawijining wangun bal kang kapérang saka mèmbran fosfolipid inang, éntuk hemagglutinin lan neuraminidase kang kakandhut sajeroning lapisan mèmbran iki (langkah 7).<ref>{{cite journal |last=Nayak |first=D |coauthors=Hui E, Barman S |title=Assembly and budding of influenza virus |journal=Virus Res |volume=106 |issue=2 |pages=147–65 |year=2004 |month=December |pmid=15567494 |doi=10.1016/j.virusres.2004.08.012}}</ref> Kaya sadurungé, virus bakal gawé ikatan liwat hemagglutinin; virus diwasa bakal ngeculaké dhiri yèn [[neuraminidase]]é wis mecah résidhu asem sialat saka sèl inang.<ref name=Wagner/> Obat kang nyandhet neuraminidase, kaya déné [[oseltamivir]], bakal nyegah uculé virus infèksius anyar lan nyegah réplikasi virus.<ref name=Itzstein/> Sawisé uculé virus influenza anyar, sèl inang bakal mati. Amarga ora anané ènzim [[proofreading (biologi)|proofreading]] RNA, polimerase RNA kang gumantung RNA kang ngopi génom virus bakal nglakokaké kasalahan kurang luwih saben 10 éwu nukléotida, kang selaras karo rata-rata saka vRNA influenza. Mula saka iku, sapérangan gedhé saka virus influenza kang rampung dironcé iku mutan; iki bakal nimbulaké [[hanyutan antigèn]], kang wujud owah-owahan alon ing antigèn ing lumahing virus sairing karo lumakuné wektu.<ref>{{cite journal |last=Drake |first=J |title=Rates of spontaneous mutation among RNA viruses |journal=Proc Natl Acad Sci USA |volume=90 |issue=9 |pages=4171–5 |year=1993 |month=1 May|pmid=8387212 |doi=10.1073/pnas.90.9.4171 |pmc=46468}}</ref> Pamisahan génom dadi wolu sègmèn vRNA kang kapisah mungkinaké panyampuran utawa [[reassortment]] saka vRNA yèn punjul sajinis virus influenza nginfèksi sawijining sèl tunggal. Iki bakal nimbulaké owah-owahan rikat saka génétika virus kang bakal nimbulaké [[papindhahan antigèn]], kang wujud owah-owahan dumadakan saka sawijining antigèn menyang antigèn liyané. Owah-owahan gedhé kang dadakan mungkinaké virus kanggo nginfèksi spésies inang anyar lan bisa kanthi rikat ngatasi kakebalan protèktif kang wis ana.<ref name=Hilleman/> Iki wigati sajeroning mékanisme munculé pandemi, kang didhiskusikaké ing ngisor iki sajeroning pérangan [[#Epidemiologi|Epidemiologi]]. == Tandha lan tandha-tandha == {| class="wikitable" style="float:right; text-align:center; width:40%;" |+ Tandha-tandha kang paling sènsitif kanggo ndhiagnosis influenza <ref name="pmid15728170"/> ! Tandha-tandha: !! [[Sènsitivitas (pacoban)|Sènsitivitas]] !! [[Spésifisitas (pacoban)|Spésivisitas]] |- ! Mriyang |68–86% ||25–73% |- ! Watuk |84–98% || 7–29% |- ! Irung mampet |68–91% ||19–41% |- | colspan="3" style="text-align:left;"| <small> * Katelu temuan mau, mligi mriyang, kurang sènsitif marang pasièn kanthi umur punjul 60 taun.</small> |} Tandha-tandha influenza bisa diwiwiti kanthi rikat, sadina nganti rong dina sawisé infèksi. Lumrahé tandha-tandha pisanan ya iku ndrodhog utawa rumangsa adhem, nanging mriyang uga asring dumadi ing awal infèksi, kanthi suhu awak watara 38-39&nbsp;°C (kurang luwih 100-103&nbsp;°F).<ref>{{cite journal |author=Suzuki E, Ichihara K, Johnson AM |title=Natural course of fever during influenza virus infection in children |journal=Clin Pediatr (Phila) |volume=46 |issue=1 |pages=76–9 |year=2007 |month=January |pmid=17164515 |doi=10.1177/0009922806289588}}</ref> Akèh wong krasa lara banget saéngga ora bisa tangi saka papan anggoné turu suwéné pirang-pirang dina, kanthi rasa lara lan nyeri saawak, kang krasa luwih abot ing tlatah geger lan sikil.<ref name=Merck /> Tandha-tandha influenza bisa ngambah: * Mriyang lan krasa adhem kang èkstrem (ndrodhog, gumeter) * Watuk * Irung mampet * Nyeri awak, mligi sendhi lan tenggorok * Kekeselen * Nyeri sirah * Iritasi mata, mata mbanyu * Mata abang, kulit abang (mligi rai), sarta semu abang ing tutuk, tenggorok, lan irung * [[Ruam petechiae]] <ref name="pmid10476766">{{cite journal |author=Silva ME, Cherry JD, Wilton RJ, Ghafouri NM, Bruckner DA, Miller MJ |title=Acute fever and petechial rash associated with influenza A virus infection |journal=Clinical Infectious Diseases: an Official Publication of the Infectious Diseases Society of America |volume=29 |issue=2 |pages=453–4 |year=1999 |month=August |pmid=10476766 |doi=10.1086/520240}}</ref> * Ing bocah, tandha-tandha gastrointestinal kaya déné [[diare]] lan nyeri [[abdomen]],<ref name=Richards/><ref>{{cite journal |author=Heikkinen T |title=Influenza in children |journal=Acta Paediatr. |volume=95 |issue=7 |pages=778–84 |year=2006 |month=July |pmid=16801171 |doi=10.1080/08035250600612272}}</ref> (bisa dumadi parah ing bocah kanthi influenza B) <ref>{{cite journal |author=Kerr AA, McQuillin J, Downham MA, Gardner PS |title=Gastric 'flu influenza B causing abdominal symptoms in children |journal=Lancet |volume=1 |issue=7902 |pages=291–5 |year=1975 |pmid=46444 |doi=10.1016/S0140-6736(75)91205-2}}</ref> Sok-sok angèl mbédakaké antarané [[selesma]] lan influenza ing tahap awal saka infèksi iki,<ref name=Eccles/> nanging flu bisa diidhèntifikasi yèn ana mriyang dhuwur ndadak kanthi rasa kesel kang èkstrém. Diare lumrahé dudu tandha-tandha saka influenza bocah,<ref name="pmid15728170"/> nanging iki bisa ditemoni ing sapérangan kasus "flu manuk" H5N1 ing manungsa<ref>{{cite journal |author=Hui DS |title=Review of clinical symptoms and spectrum in humans with influenza A/H5N1 infection |journal=Respirology |volume=13 Suppl 1 |issue=|pages=S10–3 |year=2008 |month=March |pmid=18366521 |doi=10.1111/j.1440-1843.2008.01247.x}}</ref> lan bisa dadi tandha-tandha ing bocah-bocah.<ref name=Richards>{{cite journal |author=Richards S |title=Flu blues |journal=Nurs Stand |volume=20 |issue=8 |pages=26–7 |year=2005 |pmid=16295596}}</ref> Tandha-tandha kang paling asring ana ing influenza dituduhaké ing tabèl ing sisih tengen.<ref name="pmid15728170">{{cite journal |author=Call S, Vollenweider M, Hornung C, Simel D, McKinney W |title=Does this patient have influenza? |journal=JAMA |volume=293 |issue=8 |pages=987–97 |year=2005 |doi=10.1001/jama.293.8.987 |pmid=15728170}}</ref> Amarga obat-obat antivirus èfèktif sajeroning nambani influenza yèn diwènèhaké kawit awal (deleng pérangan [[#Terapi|terapi]] ing ngisor), wigati kanggo ngidhèntifikasi kasus kanthi gasik. Saka tandha-tandha-tandha-tandha kang disebutaké ing ndhuwur, kombinasi mriyang karo watuk, nyeri tenggorok lan/utawa irung mampet bisa ngundhakaké akurasi diagnositik.<ref name="pmid11088084">{{cite journal |author=Monto A, Gravenstein S, Elliott M, Colopy M, Schweinle J |title=Clinical signs and symptoms predicting influenza infection |journal=Arch Intern Med |volume=160 |issue=21 |pages=3243–7 |year=2000 |pmid=11088084 | doi=10.1001/archinte.160.21.3243 |url=http://archinte.ama-assn.org/cgi/content/abstract/160/21/3243}}</ref> Loro panalitèn analisis kaputusan<ref name="pmif12361816">{{cite journal |author=Smith K, Roberts M |title=Cost-effectiveness of newer treatment strategies for influenza |journal=Am J Med |volume=113 |issue=4 |pages=300–7 |year=2002 |doi=10.1016/S0002-9343(02)01222-6 |pmid=12361816}}</ref><ref name="pimd12965940">{{cite journal |author=Rothberg M, Bellantonio S, Rose D |title=Management of influenza in adults older than 65 years of age: cost-effectiveness of rapid testing and antiviral therapy |journal=Ann Intern Med |volume=139 |issue=5 Pt 1 |pages=321–9 |date=2 September 2003|url=http://www.annals.org/cgi/content/abstract/139/5_Part_1/321 |pmid=12965940 }}</ref> nuduhaké yèn nalika ana wabah influenza lokal, [[prevalensi]]né punjul 70%,<ref name="pimd12965940"/> Mula pasièn kanthi salah siji kombinasi saka tandha-tandha mau bisa ditambani kanthi [[inhibitor neuraminidase]] tanpa pamriksan. Malah nalika ora anané wabah lokal, pangobatan bisa dibeneraké ing pasièn tuwa nalika mangsa influenza suwéné prévalènsiné punjul 15%.<ref name="pimd12965940"/> Kasumadyan pamriksan laboratorium kanggo influenza terus ngalami paningkatan. [[Punjer Pangendhalian lan Panyegahan Lelara]] (CDC) Amérikah Sarékat, ngrangkum pamriksan laboratorium paling anyar kang cumawis.<ref>Centers for Disease Control and Prevention. [http://www.cdc.gov/flu/professionals/diagnosis/ Lab Diagnosis of Influenza.] Diaksès 1 Mèi 2009</ref> Miturut CDC, pamriksan diagnostik rikat (rapid diagnostic test) duwé sènsitivitas 70-75% lan spésifisitas 90-95% dibandhingaké karo kultur virus. Pamriksan iki mligi migunani ing mangsa influenza (prévalènsi = 25%) tanpa anané wabah langsung, utawa mangsa periinfluenza (prévalènsi = 10%<ref name="pimd12965940"/>). == Mekanisme == === Panularan === ''Shedding'' virus influenza (wektu ing ngendi sawijining wong bisa nularaké virus marang wong liya) diwiwiti sadina sadurungé tandha-tandha muncul lan virus bakal diuculaké suwéné antara 5 tekan 7 dina, sanajan sapérangan wong mungkin ngeculaké virus suwéné périodhe kang luwih suwé. Wong kang katular influenza paling infèktif ing dina kaloro lan katelu sawisé infèksi.<ref name=Carrat>{{cite journal |author=Carrat F, Luong J, Lao H, Sallé A, Lajaunie C, Wackernagel H |title=A 'small-world-like' modhèl for comparing interventions aimed at preventing and controlling influenza pandemics |pmc=1626479 |journal=BMC Med |volume=4 |issue=|page=26 |year=2006|pmid=17059593 |doi=10.1186/1741-7015-4-26}}</ref> Gunggung virus kang diculaké katoné gegandhèngan karo mriyang, gunggung virus kang diculaké luwih gedhé nalika suhuné luwih dhuwur.<ref>{{cite web|publisher=Centers for Disease Control and Prevention|title = CDC H1N1 Flu : Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season|url=http://www.cdc.gov/h1n1flu/recommendations.htm}}</ref> Bocah-bocah luwih infèksius tinimbang wong diwasa lan bocah mau ngeculaké virus sadurungé ngalami tandha-tandha nganti rong minggu sawisé infèksi.<ref name=Carrat/><ref>{{cite journal |author=Mitamura K, Sugaya N |title=[Diagnosis and Treatment of influenza—clinical investigation on [[viral shedding]] in children with influenza] |journal=Uirusu |volume=56 |issue=1 |pages=109–16 |year=2006 |pmid=17038819 |doi=10.2222/jsv.56.109}}</ref> Panularan influenza bisa [[modhèl matématis lelara nular|dimodhèlaké kanthi matématis]], kang bakal mbantu sajeroning prédhiksi kepriyé virus nyebar sajeroning populasi.<ref>{{cite journal |author=Grassly NC, Fraser C |title=Mathematical models of infectious disease transmission |journal=Nat. Rev. Microbiol. |volume=6 |issue=6 |pages=477–87 |year=2008 |month=June |pmid=18533288 |doi=10.1038/nrmicro1845}}</ref> Influenza bisa disebaraké sajeroning telu cara utama:<ref name=Weber>{{cite journal |author=Weber TP, Stilianakis NI |title=Inactivation of influenza A viruses in the environment and modes of transmission: a critical review |journal=J. Infect. |volume=57 |issue=5 |pages=361–73 |year=2008 |month=November |pmid=18848358 |doi=10.1016/j.jinf.2008.08.013}}</ref><ref>{{cite journal |author=Hall CB |title=The spread of influenza and other respiratory viruses: complexities and conjectures |journal=Clin. Infect. Dis. |volume=45 |issue=3 |pages=353–9 |year=2007 |month=August |pmid=17599315 |doi=10.1086/519433 |url=http://www.journals.uchicago.edu/doi/full/10.1086/519433}}</ref> lumantar panularan langsung (nalika wong kang kainfèksi wahing, ana ilu irung kang mlebu kanthi langsung menyang mata, irung, lan tutuk saka wong liya); lumantar udara (nalika sawijining wong nyedhot aerosol (butiran cuwèran cilik sajeroning udara) kang diasilaké nalika wong kang kainfèksi watuk, wahing, utawa idu), lan lumantar panularan tangan-menyang-mata, tangan-menyang-irung, utawa tangan-menyang-tutuk, saka lumahan kang kakontaminasi utawa saka kontak personal langsung kaya déné salaman. Modhèl panularan endi kang paling wigati isih durung cetha, nanging kabèh duwé kontribusi sajeroning panyebaran virus.<ref name=Brankston>{{cite journal |author=Brankston G, Gitterman L, Hirji Z, Lemieux C, Gardam M |title=Transmission of influenza A in human beings |journal=Lancet Infect Dis |volume=7 |issue=4 |pages=257–65 |year=2007 |month=April |pmid=17376383 |doi=10.1016/S1473-3099(07)70029-4}}</ref><ref>{{cite journal |author=Tellier R |title=Review of aerosol transmission of influenza A virus |journal=Emerging Infect. Dis. |volume=12 |issue=11 |pages=1657–62 |year=2006 |month=November |pmid=17283614 |doi=|url=http://www.cdc.gov/ncidod/EID/vol12no11/06-0426.htm}}</ref> Ing rute panularan udara, ukuran droplèt kang cukup cilik kanggo disedhot duwé dhiameter 0,5 nganti 5 [[Mikrometer|μm]] lan inhalasi sadroplèt mungkin cukup kanggo nimbulaké infèksi.<ref name=Weber/> Sanajan sapisan wahing bisa ngeculaké nganti 40.000 droplèt,<ref name=Cole_1998>{{cite journal |author=Cole E, Cook C |title=Characterization of infectious aerosols in health care facilities: an aid to effective engineering controls and preventive strategies |journal=Am J Infect Control |volume=26 |issue=4 |pages=453–64 |year=1998 |pmid=9721404 | doi=10.1016/S0196-6553(98)70046-X}}</ref> sapérangan gedhé saka droplèt mau cukup gedhé lan bakal ilang saka udara kanthi rikat.<ref name=Weber/> Pira suwéné virus influenza bisa tahan sajeroning droplèt udara katoné diprabawai déning kadhar kalembaban lan [[Ultraungu|radhiasi ultraviolèt]]: kalembaban asor lan kurangé [[cahya]] [[srengéngé]] ing [[mangsa adhem]] mbantu tahané virus iki.<ref name=Weber/> Amarga virus influenza bisa tahan ing njaba awak, virus iki uga bisa ditularaké liwat lumahan kang kakontaminasi kaya déné lembaran [[dhuwit]],<ref name=Thomas>{{cite journal |author=Thomas Y, Vogel G, Wunderli W, ''et al.'' |title=Survival of influenza virus on banknotes |journal=Appl. Environ. Microbiol. |volume=74 |issue=10 |pages=3002–7 |year=2008 |month=May |pmid=18359825 |pmc=2394922 |doi=10.1128/AEM.00076-08}}</ref> gagang lawang, saklar lampu, lan bandha-bandha rumah tangga liyané.<ref name=Merck/> Suwéné wektu virus bisa tahan marang sawijining lumahan manéka wektuné, virus bisa tahan suwéné sadina utawa rong dina ing lumahan kang atos lan ora duwé pori kaya déné [[plastik]] utawa métal, suwéné kurang luwih limalas menit ing [[kertas]] tissue garing, lan mung limang menit ing [[kulit]].<ref name=Moore>{{cite journal |author=Bean B, Moore BM, Sterner B, Peterson LR, Gerding DN, Balfour HH |title=Survival of influenza viruses on environmental surfaces |journal=J. Infect. Dis. |volume=146 |issue=1 |pages=47–51 |year=1982 |month=July |pmid=6282993}}</ref> Nanging, yèn virus ana sajeroning mukus/lendhir, lendhir mau bisa ngreksa virus saéngga tahan ing sajeroning wektu kang suwé (nganti 17 dina ing dhuwit kertas).<ref name=Weber/><ref name=Thomas/> Virus flu manuk bisa tahan ing sajeroning wektu kang durung dikawruhi nalika ana sajeroning kaanan beku.<ref name=cfsph>{{cite web |url=http://www.cfsph.iastate.edu/Factsheets/pdfs/influenza.pdf |title=Influenza Factsheet|publisher=Center for Food Security and Public Health, Iowa State University}} hal. 7</ref> Virus ngalami inaktivasi déning pamanasan nganti 56&nbsp;°C (133&nbsp;°F) suwéné minimun 60 menit, lan uga déning asem (ing pH <2).<ref name=cfsph/> === Patofisiologi === Mékanisme kepriyé infèksi influenza bisa nimbulaké tandha-tandha ing manungsa wis disinaoni kanthi intènsif. Salah saji mékanisme kang dipercaya ya iku kanthi inhibisi hormon adrenokortikotropik (ACTH/Adrenocorticotropic Hormone) kang nimbulaké pamudhunan kadhar hormon kortisol.<ref name=jefferies1998>{{cite journal |author=Jefferies WM, Turner JC, Lobo M, Gwaltney JM Jr. |title=Low plasma levels of adrenocorticotropic hormone in patients with acute influenza.|journal=Clin Infect Dis. |volume= 26|issue=26 |pages=708–10 |url=http://www.journals.uchicago.edu/doi/pdf/10.1086/514594 |year=1998 |pmid=9524849 |pmc= |doi=10.1086/514594}}</ref> Ngawruhi gèn endi kang sok sajeroning galur virus tinentu bisa mbiyantu mrédhiksi kepriyé virus mau bisa nular lan sepira aboté infèksi kang bakal dumadi (mrédhiksi [[patofisiologi]] saka sawijining galur virus).<ref name=Taubenberger2008>{{cite journal | last1 = Taubenberger | first1 = JK | last2 = Morens | first2 = DM |title=The pathology of influenza virus infections |journal=Annu Rev Pathol |volume=3 |issue=|pages=499–522 |year=2008 |pmid=18039138 |pmc=2504709 |doi=10.1146/annurev.pathmechdis.3.121806.154316}}</ref><ref name=Korteweg>{{cite journal |author=Korteweg C, Gu J |title=Pathology, molecular biology, and pathogenesis of avian influenza A (H5N1) infection in humans |journal=Am. J. Pathol. |volume=172 |issue=5 |pages=1155–70 |year=2008 |month=May |pmid=18403604 |pmc=2329826 |doi=10.2353/ajpath.2008.070791}}</ref> Contoné, péranganing prosès kang mungkinaké virus influenza nginvasi sawijining sèl ya iku panguraian saka protèin hemagglutinin virus déning salah saji ènzim [[protease]] manungsa.<ref name=Steinhauer/> Ing virus kang infèksiné asifat ringan lan avirulèn, struktur hémagglutinin kang ana mung bisa diurai déning protease kang tinemu sajeroning tenggorok lan paru, saéngga virus iki ora bisa nginfèksi jaringan liya. Nanging, ing galur kang virulèn banget, kaya ta H5N1, hémagglutinin kang kakandhut sajeroning virus bisa diurai déning variétas protease kang manéka, saéngga mungkinaké virus nyebar menyang sakabèhing awak.<ref name=Korteweg/> Protèin hémagglutinin virus duwé tanggung jawab sajeroning nemtokaké spésiès endi kang bisa diinfèksi déning sawijining galur virus uga papan [[saluran ambegan]] endi kang bisa duwé ikatan karo sawijining galur virus influenza.<ref>{{cite journal |author=Nicholls JM, Chan RW, Russell RJ, Air GM, Peiris JS |title=Evolving complexities of influenza virus and its receptors |journal=Trends Microbiol. |volume=16 |issue=4 |pages=149–57 |year=2008 |month=April |pmid=18375125 |doi=10.1016/j.tim.2008.01.008}}</ref> Galur kang bisa ditularaké kanthi gampang saka manungsa-marang-manungsa duwé protèin hémagglutinin kang duwé ikatan karo résèptor ing saluran ambegan pérangan ndhuwur, kaya ta ing irung, tenggorok, lan tutuk. Suwaliké, strain H5N1 kang mbebayani banget duwé ikatan karo résèptor kang paling akèh tinemu ing njero paru.<ref>{{cite journal |author=van Riel D, Munster VJ, de Wit E, ''et al.'' |title=H5N1 Virus Attachment to Lower Respiratory Tract |journal=Science |volume=312 |issue=5772 |page=399 |year=2006 |month=April |pmid=16556800 |doi=10.1126/science.1125548}}</ref> Prabédan ing papan infèksi iki mungkin wujud péranganing alesan ngapa galur H5N1 nimbulaké pnéumonia virus kang abot ing paru, nanging ora ditularaké kanthi gampang liwat watuk lan wahing.<ref>{{cite journal |author=Shinya K, Ebina M, Yamada S, Ono M, Kasai N, Kawaoka Y |title=Avian flu: influenza virus receptors in the human airway |journal=Nature |volume=440 |issue=7083 |pages=435–6 |year=2006 |month=March |pmid=16554799 |doi=10.1038/440435a}}</ref><ref>{{cite journal |author=van Riel D, Munster VJ, de Wit E, ''et al.'' |title=Human and avian influenza viruses target different cells in the lower respiratory tract of humans and other mammals |journal=Am. J. Pathol. |volume=171 |issue=4 |pages=1215–23 |year=2007 |month=October |pmid=17717141 |pmc=1988871 |doi=10.2353/ajpath.2007.070248}}</ref> Tandha-tandha kang asring ana ing flu kaya ta mriyang, sirak cekot-cekot, lan kekeselen wujud asil saka sapérangan gedhé [[sitokin]] lan [[chemokin]] proinflamasi (kaya ta [[interferon]] utawa ''[[tumor necrosis factor]]'' (TNF)) kang diprodhuksi déning sèl kang kainfèksi influenza.<ref name=Eccles/><ref>{{cite journal |author=Schmitz N, Kurrer M, Bachmann M, Kopf M |title=Interleukin-1 is responsible for acute lung immunopathology but increases survival of respiratory influenza virus infection |journal=J Virol |volume=79 |issue=10 |pages=6441–8 |year=2005 |pmid=15858027 | doi=10.1128/JVI.79.10.6441-6448.2005 |pmc=1091664}}</ref> Ora kaya rhinovirus kang nimbulaké selesma (common cold/masuk angin), influenza nimbulaké karusakan jaringan, saéngga tandha-tandha kang dumadi ora kabèh disebabaké déning rèspons inflamasi.<ref>{{cite journal |author=Winther B, Gwaltney J, Mygind N, Hendley J |title=Viral-induced rhinitis |journal=Am J Rhinol |volume=12 |issue=1 |pages=17–20 |year=1998|pmid=9513654 |doi=10.2500/105065898782102954}}</ref> Rèspons imun kang gedhé iki bisa nimbulaké “badai sitokin” kang bisa ngancam nyawa. Kadadéan iki dinuga wujud jalaran saka pati kang ora biyasa ing flu manuk H5N1,<ref>{{cite journal |author=Cheung CY, Poon LL, Lau AS, ''et al.'' |title=Induction of proinflammatory cytokines in human macrophages by influenza A (H5N1) viruses: a mechanism for the unusual severity of human disease? |journal=Lancet |volume=360 |issue=9348 |pages=1831–7 |year=2002 |month=December |pmid=12480361 |doi=10.1016/S0140-6736(02)11772-7}}</ref> lan galur pandemik 1918.<ref>{{cite journal |author=Kobasa D, Jones SM, Shinya K, ''et al.'' |title=Aberrant innate immune response in lethal infection of macaques with the 1918 influenza virus |journal=Nature |volume=445 |issue=7125 |pages=319–23 |year=2007 |month=January |pmid=17230189 |doi=10.1038/nature05495 |last12=Alimonti |first12=JB |last13=Fernando |first13=L |last14=Li |first14=Y |last15=Katze |first15=MG |last16=Feldmann |first16=H |last17=Kawaoka |first17=Y}}</ref><ref>{{cite journal |author=Kash JC, Tumpey TM, Proll SC, ''et al.'' |title=Genomic analysis of increased host immune and cell death responses induced by 1918 influenza virus |journal=Nature |volume=443 |issue=7111 |pages=578–81 |year=2006 |month=October |pmid=17006449 |pmc=2615558 |doi=10.1038/nature05181 |last12=Katze |first12=MG}}</ref> Nanging, kamungkinan liyané ya iku sapérangan gedhé sitokin kang diasilaké mung wujud asil saka réplikasi virus kang gedhé banget kang ditimbulaké déning galur mau, lan rèspons imun ora mènèhi kontribusi marang lelara.<ref name=Beigel/> == Panyegahan == === Vaksinasi === Vaksinasi marang influenza kanthi vaksin influenza asring dirékomendhasikaké marang golongan risiko dhuwur, kaya ta bocah-bocah lan lansia, utawa marang panandhang [[asma]], [[diabetes]], [[lelara jantung]], utawa wong-wong kang ngalami gangguan imun. Vaksin influenza bisa diprodhuksi liwat sapérangan cara; cara kang paling umum ya iku kanthi nuwuhaké virus ing endhog pitik kang wis diwohi. Sawisé dimurnèkaké, virus banjur bakal diaktivasi (upamané, mawa détergen) kanggo ngasilaké vaksin virus kang ora aktif. Minangka alternatif, virus bisa dituwuhaké ing endhog nganti kélangan virulensiné banjur virus kang avirulen diwènèhaké minangka vaksin urip.<ref name=Hilleman/> Èfèktivitas saka vaksin influenza iku manéka rupa. Amarga tingkat mutasi virus kang dhuwur banget, vaksin influenza tinentu lumrahé mènèhaké pangreksan suwéné ora punjul sapérangan dina. Saben tauné, WHO mrédhiksikaké galur virus endi kang paling mungkin sirkulasi ing taun sabanjuré, saéngga mungkinaké perusahaan farmasi kanggo ngembangaké vaksin kang bakal nyumadyakaké kakebalan kang paling apik marang galur mau.<ref name=WHOrecommendation/> Vaksin uga wis dikembangaké kanggo ngreksa sato iwèn unggas saka flu manuk. Vaksin iki bisa èfèktif marang sapérangan galur lan minangka strategi preventif, utawa dikombinasikaké karo culling (pamuliaan) minangka usaha kanggo nyuresaké wabah.<ref>{{cite journal |last=Capua |first=I |coauthors=Alexander D |title=The challenge of avian influenza to the veterinary community |url=http://www.informaworld.com/smpp/section?content=a747651074&fulltext=713240928 |journal=Avian Pathol |volume=35 |issue=3 |pages=189–205 |year=2006 |pmid=16753610 |doi=10.1080/03079450600717174}}</ref> Ana kamungkinan kena influenza sanajan wis divaksin. Vaksin bakal diformulasi ulang saben mangsa kanggo galur flu spésifik nanging ora bisa nyakup kabèh galur kang kanthi aktif nginfèksi kabèh manungsa ing mangsa mau. Merlokaké wektu suwéné enem sasi manèh manufaktur kanggo mformulasikaké lan mrodhuksi mayuta-yuta dosis kang diperlokaké kanggo ngadhepi epidemi mangsan; sok-sok, galur anyar utawa galur kang ora dinuga pinunjul ing wektu tinentu lan nginfèksi wong-wong sanajan wong-wong mau wis divaksinasi (kaya déné kang dumadi ing [[flu Fujian|Flu Fujian H3N2]] ing mungsa flu 2003-2004).<ref>{{cite journal |last=Holmes |first=E |coauthors=Ghedin E, Miller N, Taylor J, Bao Y, St George K, Grenfell B, Salzberg S, Fraser C, Lipman D, Taubenberger J |title=Whole-genome analysis of human influenza A virus reveals multiple persistent lineages and reassortment among recent H3N2 viruses |journal=PLoS Biol |volume=3 |issue=9 |pages=e300 |year=2005 | month = September |pmid=16026181 |doi=10.1371/journal.pbio.0030300 |pmc=1180517}}</ref> Uga ana kamungkinan éntuk infèksi sadurungé vaksinasi lan dadi lara déning galur kang kuduné dicegah déning vaksinasi, amarga vaksin merlokaké wektu rong minggu sadurungé dadi èfèktif.<ref name=CDCkeyfacts/> Ing muangsa 2006-2007, CDC kaping pisanané ngrékomendasikaké bocah kang umuré kurang saka 59 sasi kanggo nampa vaksin influenza taunan.<ref name=cdcreport>{{cite journal | author = Smith NM, Bresee JS, Shay DK, Uyeki TM, Cox NJ, Strikas RA | title = Prevention and Control of Influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP) | journal = [[MMWR Recomm Rep]] | volume = 55 | issue = RR-10 | pages = 1–42 | year = 2006 | month = July | pmid = 16874296 | url = http://www.cdc.gov/mmwr/PDF/rr/rr5510.pdf }}</ref> Vaksin bisa nimbulaké sistem imun kanggo réaksi nalika awak nampa infèksi kang sabeneré, lan tandha-tandha infèksi umum (akèh tandha-tandha selesma lan flu mung wujud tandha-tandha infèksi umum) bisa mijil, sanajan tandha-tandha mau lumrahé ora padha aboté utawa tahan suwéné influenza. Èfèk samping kang paling mbebayani ya iku réaksi alèrgi abot ing matérial virus uga résidu saka endhog pitik kang dipigunakaké kanggo nuwuhaké virus influenza; nanging réaksi mau arang banget.<ref>[http://www.cdc.gov/flu/about/qa/flushot.htm Questions & Answers: Flu Shot] Publikasi CDC dianyaraké 24 Juli 2006. Diaksès 19 Oktober 2006.</ref> Minangka tambahan saliyané vaksinasi marang influenza mangsan, paneliti ngupaya kanggo ngembangaké vaksin marang kamungkinan pandemi influenza. Perkembangan, prodhuksi, lan distribusi vaksin inluenza pandemik kang rikat bisa nylametaké nyawa mayuta-yuta wong nalika dumadi pandemi influenza. Amarga mung ana wektu kang cendhak antarané idhèntifikasi galur pandemik lan kabutuhan vaksinasi, para paneliti lagi nggolèk pilihan moda prodhuksi vaksin saliyané liwat endhog. Tèknologi vaksin urip kang diinaktivasi (kanthi basis endhog utawa kanthi basis sèl), lan tèknologi rékombinan (protèin lan partikel mèmper virus), bakal mènèhaké aksès wektu nyata (''real time'') kang luwih apik lan bisa diprodhuksi kanthi luwih kejangkau, saéngga ngundhakaké aksès kanggo wong-wong kang urip ing nagara-nagara kanthi pangasilan sedheng lan asor, ing endi dadi asal kamungkinan pandemi. Tekan Juli 2009, punjul 70 uji klinis kang dikawruhi wis ditindakaké utawa lagi ditindakaké ngenani vaksin influenza pandemi.<ref>World Health Organization. Tables on the Clinical trials of pandemic influenza prototype vaccines. Juli 2009. http://www.who.int/vaccine_research/immunogenicity/immunogenicity_table.xls</ref> Ing sasi September 2009, Badan POM Amérikah Sarékat nyarujuki papat vaksin marang virus influenza H1N1 2009 (galur pandemik nalika wektu iku), lan njaluk stok vaksin mau sumadiya sajeroning sasi sabanjuré.<ref>US Food & Drug Administration. FDA Approves Vaccines for 2009 H1N1 Influenza Virus Approval Provides Important Tool to Fight Pandemic. 15 September 2009. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm182399.htm</ref> === Pangendhalian infèksi === Cara kang cukup èfèktif kanggo ngedhunaké panularan influenza salah sajiné ya iku njaga kaséhatan pribadi lan kabiyasan higiénis kang becik: kaya ta ora ndumuk mata, irung lan tutuk;<ref name="CDCQA">[http://www.cdc.gov/H1N1flu/qa.htm Center for Disease Control and Prevention: "QUESTIONS & ANSWERS: Novel H1N1 Flu (Swine Flu) and You"]. Diaksès 15 Dhésèmber 2009.</ref> asring ngumbah tangan (mawa banyu lan sabun, utawa mawa cuwèran pangumbah kanthi basis alkohol);<ref>{{cite journal |author=Grayson ML, Melvani S, Druce J, ''et al.'' |title=Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers |journal=Clin. Infect. Dis. |volume=48 |issue=3 |pages=285–91 |year=2009 |month=February |pmid=19115974 |doi=10.1086/595845}}</ref> nutup tutuk lan irung nalika watuk lan wahing, ngéndhani kontak cerak karo wong kang lara; lan tetep ana ing ngomahé dhéwé nalika lagi lara. Ora idu uga disaranaké.<ref name=Aledort>{{cite journal |author=Aledort JE, Lurie N, Wasserman J, Bozzette SA |title=Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base |journal=BMC Public Health |volume=7 |issue=|page=208 |year=2007 |pmid=17697389 |pmc=2040158 |doi=10.1186/1471-2458-7-208 }}</ref> Sanajan masker rai bisa mbiyantu nyegah panularan nalika ngrawat wong kang lara<ref>{{cite journal |author=MacIntyre CR, Cauchemez S, Dwyer DE, ''et al.'' |title=Face mask use and control of respiratory virus transmission in households |journal=Emerging Infect. Dis. |volume=15 |issue=2 |pages=233–41 |year=2009 |month=February |pmid=19193267 |pmc=2662657 |url=http://www.cdc.gov/eid/content/15/2/pdfs/233.pdf |doi=10.3201/eid1502.081167}}</ref><ref>{{cite journal |author=Bridges CB, Kuehnert MJ, Hall CB |title=Transmission of influenza: implications for control in health care settings |journal=Clin. Infect. Dis. |volume=37 |issue=8 |pages=1094–101 |year=2003 |month=October |pmid=14523774 |doi=10.1086/378292}}</ref> ana bukti-bukti kang matentangan ngenani mupangan babagan mau ing masarakat.<ref name=Aledort/><ref>[http://www.cdc.gov/flu/professionals/infectioncontrol/maskguidance.htm Interim Guidance for the Use of Masks to Control Influenza Transmission] ''Coordinating Center for Infectious Diseases (CCID)'' 8 Agustus 2005</ref> Ngrokok ngundhakaké risiko panularan influenza, lan uga nimbulaké tandha-tandha lelara kang luwih abot.<ref>{{Cite journal| pmid = 16231688| volume = 72| issue = 10| pages = 916–920| last = Murin| first = Susan| coauthors = Kathryn Smith Bilello| title = Respiratory tract infections: another reason not to smoke| journal = Cleveland Clinic Journal of Medicine| accessdate = 2009-10-01| year = 2005| url = http://www.ccjm.org/content/72/10/916.full.pdf | doi = 10.3949/ccjm.72.10.916}}</ref><ref>{{Cite journal| doi = 10.1056/NEJM198210213071702| issn = 0028-4793| volume = 307| issue = 17| pages = 1042–1046| last = Kark| first = J D| coauthors = M Lebiush, L Rannon| title = Cigarette smoking as a risk factor for epidemic a(h1n1) influenza in young men| journal = The New England Journal of Medicine| accessdate = 2009-10-01| year = 1982 | pmid = 7121513}}</ref> Amarga influenza nyebar liwat aerosol lan kontak karo lumahan kang kakontaminasi, pangresikan lumahan mau bisa mbiyantu nyegah sapérangan saka infèksi.<ref>{{cite journal |author=Hota B |title=Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection? |journal=Clin Infect Dis |volume=39 |issue=8 |pages=1182–9 |year=2004 |pmid=15486843 | doi=10.1086/424667}}</ref> [[Alkohol]] wujud bahan sanitasi kang èfèktif marang virus influenza, sauntara senyawa amonium kuarterner bisa dipigunakaké bebarengan karo alkohol saéngga èfèk sanitasi mau bisa tahan luwih suwé.<ref name=McDonnell>{{cite journal |author=McDonnell G, Russell A |title=Antiseptics and disinfectants: activity, action, and resistance |url=http://cmr.asm.org/cgi/reprint/12/1/147.pdf |journal=Clin Microbiol Rev |volume=12 |issue=1 |pages=147–79 |date=1 January 1999|pmid=9880479 |pmc=88911}}</ref> Ing [[rumah sakit]], senyawa amonium kuarterner lan [[bahan pamutih]] dipigunakaké kanggo ngresiki ruwangan lan piranti kang sadurungé dipigunakaké déning pasièn kanthi tandha-tandha influenza.<ref name=McDonnell/> Ing ngomah, babagan mau bisa dilakokaké kanthi èfèktif kanthi migunakaké bahan pamutih chlorine kang dièncèraké.<ref>{{cite web |url=http://www.waterandhealth.org/newsletter/new/winter_2005/chlorine_bleach.html |title=Chlorine Bleach: Helping to Manage the Flu Risk |publisher=Water Quality & Health Council |date=April 2009 |accessdate=2009-05-12}}</ref> Ing pandemi kapungkur, panutupan sekolah, gréja, lan biyoskup nyandhet panyebaran virus nanging ora duwé dampak kang gedhé marang angka pepati sakabèhé.<ref>{{cite journal |author=Hatchett RJ, Mecher CE, Lipsitch M |title=Public health interventions and epidemic intensity during the 1918 influenza pandemic |url=http://www.pnas.org/content/104/18/7582.full.pdf |journal=Proc Natl Acad Sci U S A. |volume=104 |issue=18 |pages=7582–7587 |year=2007 |pmid=17416679 | doi=10.1073/pnas.0610941104 |pmc=1849867}}</ref><ref>{{cite journal |author=Bootsma MC, Ferguson NM |title=The effect of public health measures on the 1918 influenza pandemic in U.S. cities |url=http://www.pnas.org/content/104/18/7588.full.pdf |journal=Proc Natl Acad Sci U S A. |volume=104 |issue=18 |pages=7588–7593 |year=2007 |pmid=17416677 | doi=10.1073/pnas.0611071104 |pmc=1849868}}</ref> Durung bisa dipesthèkaké apa ngedhunaké patemon publik, upamané kanthi nutup sekolah lan papan makarya, bakal ngedhunaké panularan amarga wong kang nandhang influenza bisa waé isih pindhah saka sawijining papan menyang papan liyané; panyerakan kaya iki uga bakal angèl dilakokaké lan mungkin ora disenengi.<ref name=Aledort/> Yèn sapérangan cilik wong ngalami infèksi, ngisolasi wong kang lagi lara bisa ngurangi risiko panularan.<ref name=Aledort/> == Pangobatan == Wong kang nandhang flu disaranaké kanggo akèh istirahat, minum akèh cuwèran, ngéndhani panggunaan [[alkohol]] lan [[rokok]], lan yèn diperlokaké, ngonsumsi obat kaya ta asetaminofen ([[parasetamol]]) kanggo ngredhakaké tandha-tandha mriyang lan perih otot kang gegandhèngan karo flu.<ref>{{cite web |url=http://www.nlm.nih.gov/medlineplus/ency/article/000080.htm |title=Flu: MedlinePlus Medical Encyclopedia |publisher=U.S. National Library of Medicine |accessdate=7 February 2010}}</ref> Bocah-bocah lan nom-noman kanthi tandha-tandha flu (mligi mriyang) sabeciké ngéndhani panggunaan [[aspirin]] nalika infèksi influenza (mligi influenza jinis B), amarga bisa nimbulaké [[Sindrom Reye]], sawijining lelara [[ati]] kang langka nanging duwé potènsi nimbulaké pepati.<ref>{{cite journal |last=Glasgow |first=J |coauthors=Middleton B |title=Reye syndrome — insights on causation and prognosis |url=http://adc.bmj.com/content/85/5/351.full.pdf |journal=Arch Dis Child |volume=85 |issue=5 |pages=351–3 |year=2001 |pmid=11668090 |doi=10.1136/adc.85.5.351 |pmc=1718987}}</ref> Amarga influenza disababaké déning virus, antibiotik ora duwé prabawa marang infèksi; kajaba diwènèhaké kanggo [[infèksi sékundhèr]] kaya déné [[pneumonia]] baktérialis. Pangobatan antiviral bisa èfèktif, nanging sapérangan galur influenza bisa nuduhaké résistènsi marang obat-obat antivirus baku.<ref>{{cite journal |author=Hurt AC, Ho HT, Barr I |title=Resistance to anti-influenza drugs: adamantanes and neuraminidase inhibitors |journal=Expert Rev Anti Infect Ther |volume=4 |issue=5 |pages=795–805 |year=2006 |month=October |pmid=17140356 |doi=10.1586/14787210.4.5.795}}</ref> Loro kelas obat antivirus kang dipigunakaké marang influenza ya iku inhibitor neuraminidase lan inhibitor [[protéin M2]] (derivat [[adamantane]]). Inhibitor neuraminidase saiki luwih disenengi tumrap infèksi virus amarga kurang toksik lan luwih èfèktif.<ref name=Beigel>{{cite journal |author=Beigel J, Bray M |title=Current and future antiviral therapy of severe seasonal and avian influenza |journal=Antiviral Res. |volume=78 |issue=1 |pages=91–102 |year=2008 |month=April |pmid=18328578 |pmc=2346583 |doi=10.1016/j.antiviral.2008.01.003}}</ref> CDC ngrékomendhasikaké supaya ora migunakaké inhibitor M2 ing mangsa influenza 2005-06 amarga dhuwuré tingkat [[résistènsi obat]].<ref>Centers for Disease Control and Prevention. [http://www.cdc.gov/flu/han011406.htm CDC Recommends against the Use of Amantadine and Rimantadine for the Treatment or Prophylaxis of Influenza in the United States during the 2005–06 Influenza Season.] 14 Januari 2006. Diaksès 1 Januari 2007</ref> Amarga wanita ngandhut katoné bakal kena dhampak kang luwih gedhé tinimbang populasi umum déning virus influenza H1N1 2009, pangobatan sacepeté kanthi obat-obat anti influenza wis dirékomendhasikaké.<ref>{{cite doi|10.1016/S0140-6736(09)61304-0}}</ref> Ing Konferènsi Pèrs influenza H1N1 November 2009, WHO ngrékomendhasikaké wong ing golongan risiko dhuwur, kalebu wanita ngandhut, bocah umur kurang saka rong taun lan wong kanthi masalah ambegan, supaya wiwit ngonsumsi obat-obat antivirus sacepeté sawisé ngalami tandha-tandha flu.<ref name=WHOpressconf12Nov2009>[http://www.who.int/mediacentre/vpc_transcript_12_november_09_nikki_shindo.pdf Transcript of virtual press conference with Gregory Hartl, Spokesperson for H1N1, and Dr Nikki Shindo, Medical Officer, Global Influenza Programme, World Health Organization], 12 November 2009. "... persistent or rapidly worsening symptoms should also be treated with antivirals. These symptoms include difficulty breathing and a high fever that lasts beyond 3 days... [page 1]" "... The pandemic virus can cause severe pneumonia even in healthy young people... [page 2]"</ref> Obat anti virus kang dipigunakaké kalebu oseltamivir (Tamiflu) lan zanamivir (Relenza). === Inhibitor neuraminidase === Obat-obat antivirus kaya déné [[oseltamivir]] (mèrek dagang Tamiflu) lan [[zanamivir]] (mèrek dagang Relenza) wujud [[inhibitor neuraminidase]] kang didhesain kanggo nyandhet panyebaran virus ing awak.<ref name=Neuraminidase_inhibitors>{{cite journal |last=Moscona |first=A |title=Neuraminidase inhibitors for influenza |url=http://www.nejm.org/doi/pdf/10.1056/NEJMra050740 | format = PDF |journal=N Engl J Med |volume=353 |issue=13 |pages=1363–73 |year=2005 |pmid=16192481 |doi=10.1056/NEJMra050740}}</ref> Obat-obatan iki asring èfèktif marang influenza A lan B.<ref name=Stephenson/> ''[[Cochrane Collaboration]]'' ninjo manèh obat-obat iki lan nyimpulaké yèn obat-obat iki bisa ngurangi tandha-tandha lan komplikasi.<ref name="pmid16855962">{{cite journal |last=Jefferson |first=T |coauthors=Demicheli V, Di Pietrantonj C, Jones M, Rivetti D |editor1-last=Jefferson |editor1-first=Tom |title=Neuraminidase inhibitors for preventing and treating influenza in healthy adults |journal=Cochrane Database Syst Rev |volume=3 |issue=|pages=CD001265 |year=2006|doi=10.1002/14651858.CD001265.pub2 |pmid=16855962}}</ref> Galur influenza kang béda duwé drajat résistènsi kang béda marang obat antivirus iki, lan ora mungkin kanggo mpédhiksi segedhé apa résistènsi kang diduwèni galur pandemik ing mangsa ngarep.<ref>{{cite journal |last=Webster |first=Robert G. |title=H5N1 Influenza — Continuing Evolution and Spread |url=http://www.nejm.org/doi/pdf/10.1056/NEJMp068205 | format = PDF |journal=N Engl J Med |volume=355 |issue=21 |pages=2174–77 |year=2006 |pmid=17124014 |doi=10.1056/NEJMp068205 |first2=E. A. |last2=Govorkova}}</ref> === Inhibitor M2 (adamantanes) === Obat-obat antivirus [[amantadine]] lan [[rimantadine]] bakal mblokadhe [[kanal ion]] virus (protéin M2) lan nyegah virus kanggo nginfèksi sèl.<ref name=Pinto/> Obat-obatan mau sok-sok èfèktif marang influenza yèn diwènèhaké kawit awal ing infèksi nanging mesthi ora èfèktif marang influenza B amarga virus influenza B ora duwé molekul M2.<ref name=Stephenson>{{cite journal |last=Stephenson |first=I |coauthors=Nicholson K |title=Chemotherapeutic control of influenza |url=http://jac.oxfordjournals.org/content/44/1/6.full.pdf |journal=J Antimicrob Chemother |volume=44 |issue=1 |pages=6–10 |year=1999 |pmid=10459804 |doi=10.1093/jac/44.1.6}}</ref> Résistènsi kang kaukur tumrap amantadine lan rimantadine ing isolat Amerka saka H3N2 wis ngalami paningkatan tekan 91% nalika taun 2005.<ref>{{cite journal |author=|title=High levels of adamantane resistance among influenza A (H3N2) viruses and interim guidelines for use of antiviral agents — United States, 2005–06 influenza season |url=http://www.cdc.gov/mmwr/pdf/wk/mm5502.pdf |journal=MMWR Morb Mortal Wkly Rep |volume=55 |issue=2 |pages=44–6 |year=2006 |pmid=16424859 |author1=Centers for Disease Control and Prevention (CDC)}}</ref> Dhuwuré tingkat résistènsi iki mungkin disababaké déning sumadyané wiyar saka amantadine minangka obat kang didol tanpa [[resèp dhokter]] kanggo pangobatan selesma ing nagara-nagara kaya déné Cina lan Ruslan,<ref>{{Cite journal | last1 = Bright | first1 = Rick A | last2 = Medina | first2 = Marie-jo | last3 = Xu | first3 = Xiyan | last4 = Perez-Oranaz | first4 = Gilda | last5 = Wallis | first5 = Teresa R | last6 = Davis | first6 = Xiaohong M | last7 = Povinelli | first7 = Laura | last8 = Cox | first8 = Nancy J | last9 = Klimov | first9 = Alexander I | doi = 10.1016/S0140-6736(05)67338-2 | title = Incidence of adamantane resistance among influenza A (H3N2) viruses isolated worldwide from 1994 to 2005: a cause for concern | journal = The Lancet | volume = 366 | issue = 9492 | pages = 1175–81 | year = 2005 | pmid = 16198766 }}</ref> lan panggunaané kanggo nyegah wabah influenza ing kéwan ingon unggas.<ref>{{cite journal |author=Ilyushina NA, Govorkova EA, Webster RG |title=Detection of amantadine-resistant variants among avian influenza viruses isolated in North America and Asia |journal=Virology |volume=341 |issue=1 |pages=102–6 |year=2005 |month=October |pmid=16081121 |doi=10.1016/j.virol.2005.07.003 |url=http://birdflubook.com/resources/0Ilyushinaxxx.pdf}}</ref><ref>{{cite journal |author=Parry J |title=Use of antiviral drug in poultry is blamed for drug resistant strains of avian flu |journal=BMJ |volume=331 |issue=7507 |page=10 |year=2005 |month=July |pmid=15994677 |pmc=558527 |doi=10.1136/bmj.331.7507.10}}</ref> == Prognosis == Prabawa influenza adoh luwih abot lan tahan luwih suwé tinimbang selesma. Sapérangan gedhé wong bakal mari dhéwé ing sajeroning wektu seminggu tekan rong minggu, nanging kang liyané bakal ngalami komplikasi kang ngancam nyawa (kaya déné pneumonia). Influenza misa njalari pepati, mligi ing wong kang lemah, enom lan tuwa, utawa ngalami lelara kronis.<ref name=Hilleman/> Wong-wong kanthi sistem imun kang lemah, kaya déné panandhang infèksi [[HIV]] tingkat lanjut utawa pasièn panampa transplan (kang sistem imuné ditekan karo obat kanggo nyegah panulakan organ transplan), nandhang lelara kang luwih abot.<ref>{{cite journal |author=Hayden FG |title=Prevention and treatment of influenza in immunocompromised patients |journal=Am. J. Med. |volume=102 |issue=3A |pages=55–60; discussion 75–6 |year=1997 |month=March |pmid=10868144 |doi=10.1016/S0002-9343(97)80013-7}}</ref> Golongan risiko dhuwur liyané ya iku wanita ngandhut lan bocah cilik.<ref>{{cite journal |author=Whitley RJ, Monto AS. |title=Prevention and treatment of influenza in high-risk groups: children, pregnant women, immunocompromised hosts, and nursing home residents. |journal=J Infect Dis. |volume=194 S2 |pages=S133–8 |year=2006 |pmid=17163386 |doi=10.1086/507548|url=http://www.journals.uchicago.edu/doi/full/10.1086/507548}}</ref> Flu bisa nambah ala masalah kaséhatan kronis. wong-wong kanthi emfisema, bronkitis kronis utawa asma bisa ngalami [[dispnea|kangèlan ambegan]] nalika ngalami flu, lan influenza bisa nimbulaké saya alané lelara [[jantung koroner]] utawa [[gagal jantung kongestif]].<ref>{{cite journal |author=Angelo SJ, Marshall PS, Chrissoheris MP, Chaves AM |title=Clinical characteristics associated with poor outcome in patients acutely infected with Influenza A |journal=Conn Med |volume=68 |issue=4 |pages=199–205 |year=2004 |month=April |pmid=15095826}}</ref> Ngrokok wujud faktor risiko liya kang gegandhèngan karo lelara kang luwih abot lan mortalitas kang luwih dhuwur kang ditimbulaké déning influenza.<ref>{{cite journal |author=Murin S, Bilello K |title=Respiratory tract infections: another reason not to smoke |journal=Cleve Clin J Med |volume=72 |issue=10 |pages=916–20 |year=2005 |pmid=16231688 |doi=10.3949/ccjm.72.10.916}}</ref> Miturut WHO: “Saben mangsa adhem, puluhan yuta wong kena flu. Sapérangan gedhé mung lara lan ora nyambut gawé suwéné seminggu, sauntara para lanjut usia duwé risiko pati kang luwih dhuwur amarga lelara iki. Awaké dhéwé ngawruhi yèn kurban mati ing saindhenging donya ngluwihi atusan èwu wong saben tauné, nanging malah ing nagara maju, gunggung mau ora bisa dipesthèkaké, amarha pihak mèdhis kang duwé kuwajiban lumrahé ora mvèrifikasi wong kang mati amarga influenza lan wong kang mati kanthi lelara-mèmper-flu.”<ref>{{cite journal | last1 = Sandman | first1 = Peter M. | last2 = Lanard | first2 = Jody | year = 2005 | title = Bird Flu: Communicating the Risk | url = http://www.paho.org/English/DD/PIN/Number22_article1.htm | journal = Perspectives in Health Magazine | volume = 10 | issue = 2 | pages = 1–6 }}</ref> Malah wong séhat bisa kena, lan masalah sérius kang ditimbulaké déning influenza bisa dumadi ing umur pira waé. Wong kanthi umur punjul 50 taun, bocah kang enom banget, lan wong saka kabèh umur kanthi kaanan mèdhis kronis luwih mungkin kanggo éntuk komplikasi influenza, kaya déné pneumonia, [[bronkitis]], infèksi sinus lan kuping.<ref name=CDCkeyfacts>[http://www.cdc.gov/flu/protect/keyfacts.htm Key Facts about Influenza (Flu) Vaccine] CDC publication. Published 17 October 2006. Diaksès 18 Oktober 2006.</ref> Ing sapérangan kasus, réspons autoimun marang influenza bisa mènèhaké kontribusi marang [[sindrom Guillain-Barré]] (GBS).<ref name=Sivadon-Tardy>{{cite journal |author=Sivadon-Tardy V, Orlikowski D, Porcher R, ''et al.'' |title=Guillain-Barré syndrome and influenza virus infection |journal=Clin. Infect. Dis. |volume=48 |issue=1 |pages=48–56 |year=2009 |month=January |pmid=19025491 |doi=10.1086/594124}}</ref> Nanging, amarga akèh infèksi liya kang bisa ngundhakaké risiko lelara iki, influenza wujud jalaran kang wigati mung nalika dumadi epidemi.<ref name=Sivadon-Tardy/><ref>{{cite journal |author=Jacobs BC, Rothbarth PH, van der Meché FG, ''et al.'' |title=The spectrum of antecedent infections in Guillain-Barré syndrome: a case-control study |journal=Neurology |volume=51 |issue=4 |pages=1110–5 |year=1998 |month=October |pmid=9781538}}</ref> Sindrom iki wis dipercaya uga minangka èfèk samping kang langka saka vaksin influenza. Sanajan sawijining lapuran panalitèn mènèhaké insidensi gedhéné sakasus per sayuta vaksinasi,<ref>{{Cite journal|author=Vellozzi C, Burwen DR, Dobardzic A, Ball R, Walton K, Haber P |title=Safety of trivalent inactivated influenza vaccines in adults: Background for pandemic influenza vaccine safety monitoring |journal=Vaccine |volume=27 |issue=15 |pages=2114–2120 |year=2009 |month=March |pmid=19356614 |doi=10.1016/j.vaccine.2009.01.125}}</ref> sawijining panalitèn gedhé ing Cina, kang dilapuraké ing [[NEJM]] kang nyakup mèh 100 yuta dosis vaksin marang flu”babi” H1N1 2009 mung tinemu sewelas kasus sindrom Guillain-Barré, (0,1%) saka total insidensi ing wong kang divaksin, sabeneré luwih asor saka tingkat kedadèyan lelara ing Cina, lan ora ana èfèk samping kang tinemu; "rasio risiko-mupangat, kang biyasa ditrepaké ing vaksin lan kabèh sajeroning pangobatan médhis, banget luwih condong marang panggunaan vaksin."<ref>[https://web.archive.org/web/20110629001728/http://www.wunderground.com/DisplayHealthDay.asp?id=649531 2009 H1N1 Flu Vaccine Was Safe]</ref> Éntuk infèksi influenza dhéwé ngundhakaké risiko pepati (tekan 1 saka 10.000) lan ngundhakaké risiko ngalami GBS nganti tingkat kang luwih dhuwur tinimbang kang ditimbulaké déning panggunaan vaksin (kurang luwih kaping 10 ing panggunaan prakiran saiki).<ref>{{cite journal |author=Stowe J, Andrews N, Wise L, Miller E |title=Investigation of the temporal association of Guillain-Barre syndrome with influenza vaccine and influenzalike illness using the United Kingdom General Practice Research Database |journal=Am. J. Epidemiol. |volume=169 |issue=3 |pages=382–8 |year=2009 |month=February |pmid=19033158 |doi=10.1093/aje/kwn310 |url=http://aje.oxfordjournals.org/content/169/3/382.long}}</ref><ref>{{cite journal |author=Sivadon-Tardy V, Orlikowski D, Porcher R, ''et al.'' |title=Guillain-Barré syndrome and influenza virus infection |journal=Clin. Infect. Dis. |volume=48 |issue=1 |pages=48–56 |year=2009 |month=January |pmid=19025491 |doi=10.1086/594124 |url=http://www.journals.uchicago.edu/doi/full/10.1086/594124}}</ref> == Epidemiologi == === Variasi mangsan === Influenza nggayuh prévalènsi pucuk nalika [[mangsa adhem]], lan amarga [[wilahan bumi lor]] lan [[wilahan bumi kidul|kidul]] ngalami mangsa adhem ing wektu kang béda saben tauné, ana loro mangsa flu saben tauné. Mula WHO (dibantu déning National Influenza Centers) gawé rékomèndhasi kanggo loro formulasi vaksin saben tauné; siji kanggo wilahan bumi lor, lan siji kanggo kidul.<ref name=WHOrecommendation>[https://web.archive.org/web/20060528111237/http://www.who.int/csr/disease/influenza/2007northreport.pdf Recommended composition of influenza virus vaccines for use in the 2006–2007 influenza season] WHO report 2006-02-14. Diaksès 19 Oktober 2006.</ref> Wis suwé dadi pitakonan kenapa wabah flu dumadi kanthi mangsan, ora dumadi kanthi mangsan sadawané taun. Siji wedharan kang mungkin ya iku amarga wong ana sajeroning ruwangan luwih asring ing mangsa adhem, wong-wong mau ana sajeroning kontak cerak luwih asring, lan babagan mau ngundhakaké panularan saka wong-menyang-wong. Paningkatan tingkat lelaku amarga prèinan mangsa adhem ing wilahan bumi pérangan lor mungkin uga nyekel peranan.<ref name="NPR2003-12-17">[http://www.npr.org/templates/story/story.php?storyId=1551913 Weather and the Flu Season] NPR Day to Day, 17 December 2003. Diaksès 19 Oktober 2006</ref> Faktor liyané ya iku suhu kang adhem njalari udara luwih adhem, kang bisa nggaringaké mukus/lendhir, nyegah awak kanggo ngusir partikel virus kanthi èfèktif. Virus uga tahan luwih suwé ing lumahan ing suhu kang luwih adhem lan transmisi aerosol saka virus paling dhuwur ing lingkungan kang adhem (kurang saka 5&nbsp;°C) kanthi kalembaban rélatif kang asor.<ref>{{cite journal | title = Influenza virus transmission is dependent on relative humidity and temperature | last1 = Lowen | first1 = AC | last2 = Mubareka | first2 = S | last3 = Steel | first3 = J | last4 = Palese | first4 = P | authorlink4 = Peter Palese | journal = PLoS Pathogens | volume = 3 | issue = 10 | page = e151 | url = http://www.plospathogens.org/article/fetchObjectAttachment.action?uri=info%3Adoi%2F10.1371%2Fjournal.ppat.0030151&representation=PDF | format = PDF | doi = 10.1371/journal.ppat.0030151 | pmc = 2034399 | pmid = 17953482 | year = 2007 | month = October }}</ref> Kalembaban udara kang asor ing mangsa adhem katoné wujud jalaran utama saka transmisi influenza mangsan ing iklim sedheng.<ref>{{cite journal |author=Shaman J, Kohn M |title=Absolute humidity modulates influenza survival, transmission, and seasonality |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=106 |issue=9 |pages=3243–8 |year=2009 |month=March |pmid=19204283 |pmc=2651255 |doi=10.1073/pnas.0806852106}}</ref><ref>{{cite journal |author=Shaman J, Pitzer VE, Viboud C, Grenfell BT, Lipsitch M |editor1-last=Ferguson |editor1-first=Neil M. |title=Absolute humidity and the seasonal onset of influenza in the continental United States |journal=PLoS Biol. |volume=8 |issue=2 |pages=e1000316 |year=2010 |month=February |pmid=20186267 |pmc=2826374 |doi=10.1371/journal.pbio.1000316}}</ref> Nanging, owah-owahan mangsan ing tingkat infèksi uga dumadi ing wewengkon [[tropis]], lan ing sapérangan nagara pucuk infèksi katon mligi ing mangsa udan.<ref>{{cite journal | doi = 10.1016/S1526-0542(03)00024-1 | last1 = Shek | first1 = LP | last2 = Lee | first2 = BW | title = Epidemiology and seasonality of respiratory tract virus infections in the tropics. | journal = Paediatric respiratory reviews | volume = 4 | issue = 2 | pages = 105–11 | year = 2003 | pmid = 12758047 }}</ref> Owah-owahan mangsan sajeroning tingkat kontak kang magepokan karo mangsa sekolah (semèster) wujud faktor utama sajeroning lelara anak liyané kaya déné [[campak]] lan [[pertussis]], mungkin uga nyekel peranan sajeroning kombinasi lelara flu. Kombinasi saka èfèk mangsan cilik iki bisa digedhèkaké kanthi résonansi dinamis siklus endogen lelara.<ref>{{cite journal | last1 = Dushoff | first1 = J | last2 = Plotkin | first2 = JB | last3 = Levin | first3 = SA | last4 = Earn | first4 = DJ | title = Dynamical resonance can account for seasonality of influenza epidemics. | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 101 | issue = 48 | pages = 16915–6 | year = 2004 | pmid = 15557003 | pmc = 534740 | doi = 10.1073/pnas.0407293101 }}</ref> H5N1 nuduhaké pola mangsan ing [[manungsa]] lan unggas.<ref name=WHOH5N1data>[https://web.archive.org/web/20040218103733/http://www.who.int/csr/disease/avian_influenza/country/en/ WHO Confirmed Human Cases of H5N1] Data published by WHO Epidemic and Pandemic Alert and Response (EPR). Diaksès 24 Oktober 2006</ref> Sawijining hipotèsis alternatif kang njelasaké pola mangsan ing infèksi influenza ya iku èfèk kadhar [[vitamin D]] tumrap kakebalan marang virus.<ref>{{cite journal |last=Cannell |first=J |coauthors=Vieth R, Umhau J, Holick M, Grant W, Madronich S, Garland C, Giovannucci E |title=Epidemic influenza and vitamin D |journal=Epidemiol Infect |volume=134 |issue=6 |pages=1129–40 |year=2006 |pmid=16959053 |doi=10.1017/S0950268806007175 |pmc=2870528 |authorlink=John Cannell}}</ref> Pendhapat iki pisanan diajokaké déning [[Robert Edgar Hope-Simpson]] nalika taun 1965.<ref>{{cite journal |last=HOPE-SIMPSON |first=R |title=The nature of herpes zoster: a long-term study and a new hypothesis |journal=Proc R Soc Med |volume=58 |issue=|pages=9–20 |year=1965|pmid=14267505 |pmc=1898279}}</ref> Dhèwèké ngajokaké yèn jalaran epidemi influenza ing mangsa adhem mungkin gegandhèngan karo fluktuasi mangsan vitamin D, kang timbul ing [[kulit]] ing sangisoré prabawa [[radhiasi UV]] [[srengéngé]] (utawa radhiasi artifisial). Iki bisa njelasaké kenapa influenza dumadi mligi nalika [[mangsa adhem]] lan ing [[mangsa udan]] ing tlatah tropis, nalika wong akèh ana sajeroning ruwangan, adoh saka sinar srengéngé, lan kadhar vitamin D-né ngalami pamudhunan. === Panyebaran epidemi lan pandemi === Amarga influenza disababaké déning manéka spésiès lan galur virus, saben tauné sapérangan galur bisa cures sauntara galur kang liyané nimbulaké epidemi, sauntara galur kang liyané nimbulaké pandemi. Lumrahé, loro mangsa flu taunan (siji sajeroning sawilahan bumi), ana telu nganti limang yuta kasus abot lan nganti 500.000 pepati ing saindhenging donya, kang nyukupi kritéria epidemi influenza taunan.<ref>[http://www.who.int/mediacentre/factsheets/fs211/en/ Influenza] WHO Fact sheet No. 211 revised March 2003. Diaksès 22 Oktober 2006.</ref> Sanajan insidènsi influenza bisa banget manéka saka taun-menyang-taun, kurang luwih 36.000 pepati lan punjul 200.000 rawat inep gegandhèngan kanthi langsung karo influenza saben tauné ing Amérikah Sarékat.<ref>{{cite journal |last=Thompson |first=W |coauthors=Shay D, Weintraub E, Brammer L, Cox N, Anderson L, Fukuda K |title=Mortality associated with influenza and respiratory syncytial virus in the United States |url=http://jama.ama-assn.org/cgi/content/full/289/2/179 |journal=JAMA |volume=289 |issue=2 |pages=179–86 |year=2003 |pmid=12517228 |doi=10.1001/jama.289.2.179}}</ref><ref>{{cite journal |last=Thompson |first=W |coauthors=Shay D, Weintraub E, Brammer L, Bridges C, Cox N, Fukuda K |title=Influenza-associated hospitalizations in the United States |url=http://jama.ama-assn.org/cgi/content/full/292/11/1333 |journal=JAMA |volume=292 |issue=11 |pages=1333–40 |year=2004 |pmid=15367555 |doi=10.1001/jama.292.11.1333}}</ref> Kurang luwih kaping telu sajeroning saabad, dumadi pandemi, kang bakal nginfèksi sapérangan gedhé populasi donya lan bisa njalari patiné mayuta-yuta wong (delengen pérangan [[#sajarah|sajarah]]). Sawijining panalitèn mrakirakaké yèn sawijining galur kanthi virulènsi kang padha karo [[pandemi flu 1918|influenza 1918]] muncul saiki, mula virus mau bisa matèni 50 nganti 80 yuta wong.<ref>{{cite journal |author=Murray CJ, Lopez AD, Chin B, Feehan D, Hill KH |title=Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: a quantitative analysis |journal=Lancet |volume=368 |issue=9554 |pages=2211–8 |year=2006 |month=December |pmid=17189032 |doi=10.1016/S0140-6736(06)69895-4}}</ref> Virus influenza anyar ngalami [[évolusi]] spontan lumantar [[mutasi]] utawa lumantar reassortment.<ref name=hay/> Mutasi bisa nimbulaké owah-owahan cilik ing [[hemagglutinin]] lan antigen [[neuraminidase]] ing lumahan virus. Iki diarani antigenic drift, kang kanthi alon-alon nimbulaké akèh variasi galur nganti salah siji bisa nginfèksi manungsa kang kebal marang galur kang wis ana sadurungé. Varian anyar iki banjur nggantèkaké galur kang luwih tuwa amarga galur mau kanthi rikat nyapu populasi manungsa – asring nimbulaké epidemi.<ref>{{cite journal |author=Wolf, Yuri I|title=Long intervals of stasis punctuated by bursts of positive selection in the seasonal evolution of influenza A virus |journal=Biol Direct |volume=1 |issue=1 |page=34 |year=2006 |pmid=17067369|doi=10.1186/1745-6150-1-34 |first2=C |first3=EC |first4=EV |first5=DJ |pmc=1647279 |last2=Viboud |last3=Holmes |last4=Koonin |last5=Lipman}}</ref> Nanging, amarga galur kang ditimbulaké déning kèlinan mau bakal cukup sarupa karo galur sadurungé, sapérangan wong bakal isih imun marang virus mau. Suwaliké, yèn virus influenza ngalami reassortment, wong-wong bakal olèh antigen kang anyar – umpamané reassortment antarané galur unggas lan galur manungsa; iki diarani [[pepindhahan antigen]]. Yèn virus influenza manungsa duwé antigen kang anyar, saben wong bisa kena infèksi, lan virus influenza anyar mau bakal nyebar kanthi ora kakontrol lan nimbulaké pandemi.<ref>{{cite journal |last=Parrish |first=C |coauthors=Kawaoka Y |title=The origins of new pandemic viruses: the acquisition of new host ranges by canine parvovirus and influenza A viruses |journal=Annual Rev Microbiol |volume=59 |issue=|pages=553–86 |year=2005|pmid=16153179 |doi=10.1146/annurev.micro.59.030804.121059}}</ref> Béda karo modhèl pandemi kang didhasaraké marang katutan lan pepindhahan antigen, sawijining panyerakan alternatif wis diajokaké ing endi pandemi périodik ditimbulaké déning interaksi saka sawijining rangkéyan galur virus kang tetep karo populasi manungsa kang kanthi konstan ngalami owah-owahan imunitas marang galur virus kang béda.<ref>{{cite journal |author=Recker M, Pybus OG, Nee S, Gupta S |title=The generation of influenza outbreaks by a network of host immune responses against a limited set of antigenic types |url=http://www.pnas.org/cgi/content/full/104/18/7711 |journal=Proc Natl Acad Sci U S A. |volume=104 |issue=18 |pages=7711–7716 |year=2007 |pmid=17460037 | doi=10.1073/pnas.0702154104 |pmc=1855915}}</ref> == Sajarah == === Ètimologi === Tembung influenza asalé saka [[basa Italia]] kang tegesé “prabawa”, iki ngrujuk marang jalaran lelara; awalé lelara iki disebutaké disababaké déning prabawa [[astrologi]]s kang kurang apik.<ref>''Influenza'', [[Oxford English Dictionary|The Oxford English Dictionary]], second edition.</ref> Owah-owahan pendhapat mèdhis njalari modhifikasi jeneng dadi influenza del freddo, kang tegesé “prabawa adhem”. Tembung influenza pisanan dipigunakaké sajeroning basa Inggris kanggo nyebut lelara kang awaké dhéwé kawruhi saiki nalika taun 1703 déning J Hugger saka Univèrsitas Edinburgh sajeroning thesisé kang judhulé "''De Catarrho epidemio, vel influenza, prout in India occidentali sese ostendit''".<ref>Creighton, Charles (1965): A History Of Epidemics In Britain, With Additional Material By D.E.C. Eversley</ref> Istilah biyèn kang dipigunakaké kanggo influenza ya iku ''epidemic catarrh'', ''grippe'' (saka [[basa Prancis]], pisanan dipigunakaké déning Molyneaux nalika taun 1694<ref>{{cite journal | pmid=11576290 | last1=Potter | first1=CW | year=2001 | title=A history of influenza. | journal=Journal of applied microbiology | volume=91 | issue=4 |pages= 572–579 | doi=10.1046/j.1365-2672.2001.01492.x}}</ref>), ''sweating sickness'', lan mriyang Spanyol (mligi ing galur flu pandemi 1918).<ref>{{cite journal|last=Smith|first=P|title=Swine Flu|journal=Croatian Medical Journal|accessdate=2009-12-12|doi= 10.3325/cmj.2009.50.412|year=2009|volume=50|page=412|pmid=19673043|issue=4|pmc=2728380}}</ref> === Pandemi === Tandha-tandha influenza manungsa dijlèntrèhaké kanthi cetha déning [[Hippocrates]] kurang luwih 2.400 taun kapungkur.<ref>{{cite journal |last=Martin |first=P |coauthors=Martin-Granel E |title=2,500-year evolution of the term epidemic |url=http://www.cdc.gov/ncidod/EID/vol12no06/05-1263.htm#cit |journal=Emerg Infect Dis |year=2006 |month=June |volume=12 |issue=6 |pmid=16707055 |pages=976–80}}</ref><ref>{{cite web |author=Hippocrates |coauthors=[[Francis Adams (translator)|Adams, Francis]] (transl.) |title=Of the Epidemics |url=http://classics.mit.edu/Hippocrates/epidemics.html |date=400 BCE |accessdate=2006-10-18}}</ref> Sanajan virus katoné njalari epidemi sadawané sajarah manungsa, data historis ngenani influenza angèl kanggo diinterprétasikaké, amarga gejalané bisa sakrupa karo tandha-tandha lelara ambegan liyané.<ref>{{Cite journal| pmid = 1724803| volume = 13| issue = 2| pages = 223–234| last = Beveridge| first = W I| title = The chronicle of influenza epidemics| journal = History and Philosophy of the Life Sciences| year = 1991}}</ref><ref name=Potter/> Lelara iki mungkin wis nyebar saka Éropah menyang Amérika nalika kolonisasi Amérika déning wong-wong Éropah; amarga mèh kabèh warga [[Antilles]] mati déning epidemi kang mèmper karo influenza kang nyebar nalika taun 1493, sawisé tekané [[Christopher Columbus]].<ref>{{cite journal|doi=10.2307/1171451|author=Guerra, Francisco |title=The Earliest American Epidemic: The Influenza of 1493 |year=1988 |journal=Social Science History |volume= 12 |issue= 3 | pages=305–325|pmid=11618144|jstor=1171451 }} (only the first page can be read for free, but that has enough information about influenza being the main disease brought by Columbus killing 90 % of the indiginous population)</ref><ref>{{Cite journal| pmid = 7529930| volume = 15| issue = 3| pages = 313–327| last = Guerra| first = F| title = The European-American exchange| journal = History and Philosophy of the Life Sciences| year = 1993| doi = 10.1016/S1471-0846(02)80108-1}}</ref> Lapuran pisanan kang nyakinaké ngenani pandemi influenza ya iku wabah nalika taun 1580, kang awalé ing Ruslan lan nyebar menyang Éropah liwat Afrika. Ing [[Roma]], punjul 8.000 wong mati, lan sapérangan kutha Spanyol mèh kabèh cures. Pandemi terus lumaku kanthi sporadis tekan abad ka 17 lan 18, kanthi pandemi 1830-1833 kang mligi nyebar kanthi wiyar; pandemi mau nginfèksi kurang luwih saprapat saka warga kang kapapar.<ref name=Potter>{{cite journal |author=Potter CW |title=A History of Influenza |journal=Journal of Applied Microbiology |year=2001 |month=October |volume=91 |issue=4 |pages=572–579 |pmid=11576290 |url=http://www3.interscience.wiley.com/cgi-bin/fulltext/120718156/HTMLSTART | doi=10.1046/j.1365-2672.2001.01492.x}}</ref> Wabah kang paling misuwur lan paling matèkaké ya iku pandemi flu 1918 (pandemi flu Spanyol) (influenza jinis A, subtipe H1N1), kang dumadi antarané taun 1918 tekan 1919. Ora dikawruhi kanthi cetha sapira akèhé pati kang ditimbulaké, nanging prakirané watara 20 nganti 100 yuta wong.<ref name=Knobler>{{cite book |juru besut=Knobler S, Mack A, Mahmoud A, Lemon S |title=The Threat of Pandemic Influenza: Are We Ready? Workshop Summary (2005) |chapter=1: The Story of Influenza |pages=60–61 |chapterurl=http://books.nap.edu/openbook.php?record_id=11150&page=58 |publisher=The National Academies Press |location=Washington, D.C.}}</ref><ref name=Patterson1>{{cite journal |last=Patterson |first=KD |coauthors=Pyle GF |title=The geography and mortality of the 1918 influenza pandemic |journal=Bull Hist Med. |year=1991 |month=Spring |volume=65 |issue=1 |pages=4–21 |pmid=2021692}}</ref> Pandemi iki diarani “pambantéyan médhis gedhé dhéwé sajeroning sajarah” lan mungkin wis matèni wong padha akèhé karo [[Pepati Ireng]].<ref name=Potter/> Angka pepati kang gedhé banget iki disebabaké déning tingkat infèksi kang dhuwur banget ngancik 50% lan tingkat tandha-tandha kang abot banget, dinuga disababaké déning [[badai sitokin]].<ref name=Patterson1/> Tandha-tandha flu nalika taun 1918 ora biyasa banget nganti influenza ing awalé salah didiagnosis minangka mriyang dengue, [[kolera]], utawa uga [[mriyang tifoid]]. Sawijining pangamat nulisaké, “Salah sawijining komplikasi kang paling abot ya iku panggetihan saka [[selaput lendhir]], mligi saka [[irung]], [[lambung]], lan [[usus]]. Panggetihan saka [[kuping]] lan panggetihan [[petechia]] uga dumadi.”<ref name=Knobler/> Mayoritas pepati disababaké déning [[pneumonia bakterial]], [[infèksi sékundhèr]] kang ditimbulaké déning influenza, nanging virus uga matèni wong kanthi langsung, nimbulaké panggetihan masif lan [[edema]] paru.<ref name=autogenerated1>{{cite journal | author = Taubenberger JK, Reid AH, Janczewski TA, Fanning TG | title = Integrating historical, clinical and molecular genetic data in order to explain the origin and virulence of the 1918 Spanish influenza virus | journal = [[Philos. Trans. R. Soc. Lond., B, Biol. Sci.]] | volume = 356 | issue = 1416 | pages = 1829–39 | year = 2001 | month = December | pmid = 11779381 | pmc = 1088558 | doi = 10.1098/rstb.2001.1020 }}</ref> Pandemi flu 1918 (pandemi flu Spanyol) bener-bener mandonya, malah nyebar tekan Kutub Lor lan [[Kapuloan Pasifik]] kang adoh. Lelara kang abot banget matèni watara 2 nganti 20% saka panandhang kang kainfèksi, ora kaya tingkat pepati epidemi flu kang lumrahé mung 0,1%.<ref name=Knobler/><ref name="Taubenberger">{{cite journal |last=Taubenberger |first=J |coauthors=Morens D |title=1918 Influenza: the mother of all pandemics |url=http://www.cdc.gov/ncidod/EID/vol12no01/05-0979.htm |journal=Emerg Infect Dis |volume=12 |issue=1 |pages=15–22 |year=2006 |pmid=16494711}}</ref> Tandha-tandha liya saka pandemi iki ya iku kedadèyan iki sapérangan gedhé matèni wong diwasa enom, kanthi 99% pepati pandemi influenza dumadi ing wong-wong kanthi umur sangisoré 65, lan punjul setengahé umur 20 tekan 40 taun.<ref>{{cite journal |last=Simonsen |first=L |coauthors=Clarke M, Schonberger L, Arden N, Cox N, Fukuda K |title=Pandemic versus epidemic influenza mortality: a pattern of changing age distribution |journal=J Infect Dis |volume=178 |issue=1 |pages=53–60 |year=1998 |month=July |pmid=9652423}}</ref> Iki ora biyasa amarga influenza lumrahé paling matèkaké ing umur enom banget (sangisoré umur 2 taun) lan ing umur tuwa banget (sandhuwuré 70 taun). Mortalitas total saka pandemi 1918-1919 ora dikawruhi, nanging diprakirakaké watara 2,5% nganti 5% saka kabèh populasi donya wis mati amarga flu iki. Akèhé 25 yuta mungkin wis mati sajeroning 25 minggu pisanan; minangka tetimbangan, [[AIDS|HIV/AIDS]] wis matèni 25 yuta panandhangé sajeroning 25 taun pisanan.<ref name=Knobler/> Pandemi flu kang dumadi sabanjuré ora duwé dampak gedhé banget. Pandemi mau ya iku [[Flu Asia]] 1957 (jinis A, galur [[H2N2]]) lan [[Flu Hongkong]] 1968 (Tipe A, galur [[H3N2]]), nanging wabah kang luwih cilik iki malah matèni mayuta-yuta wong. Ing pandemi kang dumadi ing samburiné antibiotik wis sumadiya kanggo ngendhalèkaké infèksi sékundhèr lan iku wis mbiyantu ngurangi mortalitas tinimbang Flu Spanyol 1918.<ref name=Taubenberger/> {|class="wikitable" style="text-align:center" |+ [[Pandemi flu]] kang wis dikawruhi<ref name=Hilleman>{{cite journal |last=Hilleman |first=M |title=Realities and enigmas of human viral influenza: pathogenesis, epidemiology and control |journal=Vaccine |volume=20 |issue=25–26 |pages=3068–87 |year=2002 |month=August 19 |pmid=12163258 |doi=10.1016/S0264-410X(02)00254-2}}</ref><ref name=Potter/><ref name="TenThings">{{cite web |url=http://www.who.int/csr/disease/influenza/pandemic10things/en/index.html |publisher=World Health Organization |date=2005-10-14 |title=Ten things you need to know about pandemic influenza|accessdate=2009-09-26|archiveurl=http://web.archive.org/20051016015026/www.who.int/csr/disease/influenza/pandemic10things/en/index.html|archivedate=2005-10-16}}</ref> ! Jeneng pandemi !! Wektu !!Pepati !! Tingkat pepati !! Subtipe kang duwé peran !! [[Tingkat Aboté Pandemi]] |- ! [[Flu Ruslan|Flu (Ruslan) Asia]]<ref>{{cite journal |author=Valleron AJ, Cori A, Valtat S, Meurisse S, Carrat F, Boëlle PY |title=Transmissibility and geographic spread of the 1889 influenza pandemic |journal=Proc. Natl. Acad. Sci. U.S.A. |volume=107 |issue=19 |pages=8778–81 |year=2010 |month=May |pmid=20421481 |doi=10.1073/pnas.1000886107 |pmc=2889325}}</ref> |1889–1890 ||1 yuta ||0,15% ||kamungkinan [[H3N8]] ||NA |- ! [[Pandemi flu 1918]]<br />(Flu Spanyol)<ref>{{cite journal |author=Mills CE, [[James Robins|Robins JM]], Lipsitch M |title=Transmissibility of 1918 pandemic influenza |journal=Nature |volume=432 |issue=7019 |pages=904–6 |year=2004 |month=December |pmid=15602562 |doi=10.1038/nature03063 }}</ref> |1918–1920 ||20 nganti 100 yuta ||2%||[[H1N1]] ||5 |- ! [[Flu Asia]] |1957–1958 ||1 nganti 1,5 yuta ||0,13%||[[H2N2]] ||2 |- ! [[Flu Hong Kong]] |1968–1969 ||0,75 nganti 1 yuta ||<0,1%||[[H3N2]] ||2 |- ! [[Pandemi flu 2009]]<ref>{{cite journal |author=Donaldson LJ, Rutter PD, Ellis BM, ''et al.'' |title=Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study |journal=BMJ |volume=339 |issue= |pages=b5213 |year=2009 |pmid=20007665 |pmc=2791802 |doi=10.1136/bmj.b5213}}</ref> |2009–2010 ||18.000 ||0,03%||[[H1N1]] ||NA |} Virus influenza pisanan kang kasil diisolasi asalé saka unggas, nalika taun 1901 agèn kang nimbulaké lelara kang diarani “''fowl plague''” diliwataké lumantar [[filter Chamberland]], kang duwé pori kang ukurané cilik banget kanggo diliwati déning bakteria.<ref>{{cite journal |author=Heinen PP |url=http://www.vetscite.org/publish/articles/000041/print.html |title=Swine influenza: a zoanasis |journal=Veterinary Sciences Tomorrow |issn=1569-0830 |date=15 September 2003}}</ref> [[Etiologi]] influenza, famili virus Orthomyxoviridae, pisanan tinemu ing babi déning [[Richard Shope]] nalika taun 1931.<ref>{{cite journal |last=Shimizu |first=K |title=History of influenza epidemics èand discovery of influenza virus |journal=Nippon Rinsho |year=1997 |month=October |volume=55 |issue=10|pages=2505–201 |pmid=9360364}}</ref> Panemon iki banjur dimèluni déning isolasi virus saka manungsa déning saklompok panaliti kang dipanggedhèni déning [[Patrick Laidlaw]] saka [[Konsili Panalitèn Brtainia Raya]] nalika taun 1933.<ref>{{cite journal |last=Smith |first=W |coauthors=Andrewes CH, Laidlaw PP |title=A virus obtained from influenza patients |journal=Lancet |year=1933 |volume=2 |pages=66–68 |doi=10.1016/S0140-6736(00)78541-2}}</ref> Nanging, nalika taun 1935, nalika Wendell Stanley pisanan ngristalisasikaké [[tobacco mosaic virus]], sipat non sélulèr saka virus dikawruhi. Laku signifikan pisanan sajeroning nyegah influenza ya iku dikembangaké vaksin virus mati kanggo influenza nalika taun 1944 déning [[Thomas Francis, Jr.]]. Iki wujud perkembangan saka karya [[Frank Macfarlane Burnet]], sawijining wong Australia, kang nuduhaké yèn virus bakal kélangan virulènsiné nalika dhèwèké dikultur sajeroning endhog pitik kang wis dibagi.<ref name="Nobel">[http://nobelprize.org/nobel_prizes/medicine/laureates/1960/burnet-bio.html Sir Frank Macfarlane Burnet: Biography] The [[Nobel Foundation]]. Diaksès 22 Oktober 2006</ref> Aplikasi saka temon iki déning Francis mungkinaké dhèwèké lan tim panalitiné ing [[Universitas Michigan]] kanggo ngembangaké vaksin influenza pisanan, kanthi panjurung saka [[Angkatan Bersenjata Amérikah Sarékat]].<ref>{{cite journal |last=Kendall |first=H |title=Vaccine Innovation: Lessons from World War II |url=http://www.palgrave-journals.com/jphp/journal/v27/n1/abs/3200064a.html|journal=Journal of Public Health Policy |volume=27 |issue=1 |pages=38–57 |year=2006 |doi=10.1057/palgrave.jphp.3200064 |pmid=16681187}}</ref> Dinas Katentaraan duwé katerlibatan ing panalitèn iki amarga pengalaman ing influenza nalika [[Perang Donya I]], nalika èwonan wadya mati déning virus sajeroning étungan sasi.<ref name=Knobler/> Dibandhingaké karo vaksin, perkembangan obat anti-influenza luwih alon, kanthi diwetokaké lisènsi [[amantadine]] nalika taun 1966, lan mèh telung puluh taun sabanjuré, golongan obat sabanjuré ([[inhibitor neruaminidase]]) dikembangaké.<ref name=Lynch/> == Masarakat lan kabudayan == Influenza nimbulaké beban béya langsung amarga ilangé [[prodhuktivitas]] lan béya pangobatan mèdhis kang diakibataké, lan uga béya ora langsung wujud laku-laku prévèntif. Ing Amérikah Sarékat, influenza duwé tanggung jawab kanggo total beban gedhéné punjul 10 yuta dollar per taun, sauntara wis diprakirakaké yèn pandemi ing mangsa ngarèp bisa nimbulaké tuna atusan yuta dolar sajeroning wangun beban langsung lan ora langsung.<ref>[https://web.archive.org/web/20090109011356/http://www.whitehouse.gov/homeland/pandemic-influenza.html Statement from President George W. Bush on Influenza] Diakses 26 Oktober 2006</ref> Nanging, dampak [[ékanami]] saka pandemi kang sadurungé durung disinaoni kanthi intènsif, lan sapérangan panulis wis nduga yèn influenza Spanyol sabeneré duwé èfèk jangka dawa positif ing patuwuhan ''pendapatan per-kapita'', sanajan ana pamudhunan kang gedhé ing populasi punggawa lan èfèk déprèsi jangka cendhak kang abot.<ref>Brainerd, E. and M. Siegler (2003), "The Ecanamic Effects of the 1918 Influenza Epidemic", ''CEPR Discussion Paper'', no. 3791.</ref> Panalitèn liya wis ngupaya kanggo mrédhiksi beban béya saka sawijining pandemi kang padha aboté karo flu Spanyol 1918 ing ékanami Amérikah Sarékat, ing endi 30% saka kabèh punggawa dadi lara, lan 2,5% ngalami pati. Angka lelara watara 30% lan suwéné lelara watara telung minggu bakal ngedhunaké [[prodhuk dhomèstik bruto]] gedhéné 5%. Beban tambahan bisa muncul saka pangobatan mèdhis saka 18 yuta nganti 45 yuta wong, lan beban ékanami kabèh bakal dadi kurang luwih 700 yuta dolar.<ref>{{cite journal |author=Poland G |title=Vaccines against avian influenza—a race against time |url=http://content.nejm.org/cgi/content/full/354/13/1411 |journal=N Engl J Med |volume=354 |issue=13 |pages=1411–3 |year=2006 |pmid=16571885 | doi=10.1056/NEJMe068047}}</ref> Béya pancegahan uga dhuwur. Pamaréntah ing saindhenging donya wis ngentèkaké mayuta-yuta dolar Amérika sajeroning persiapan lan parencanaan sajeroning ngadhepi kamungkinan pandemi flu manuk H5N1, kanthi beban béya kang magepokan karo panukonan obat lan vaksin lan uga ngembangaké latihan bencana lan strategi sajeroning ngundhakaké [[pangawasan wewatesan]].<ref name=Rosenthal/> Pada 1 November 2005, [[Présidhèn Amérikah Sarékat]] [[George W. Bush]] mengeluarkan ''the National Strategy to Safeguard Against the Danger of Pandemic Influenza'' (Strategi Nasional kanggo Ngreksa Bebaya Pandemi influenza)<ref>[https://web.archive.org/web/20090109011356/http://www.whitehouse.gov/homeland/pandemic-influenza.html National Strategy for Pandemic Influenza] Whitehouse.gov Diaksès 26 Oktober 2006.</ref> kang dijurung déning panjaluk dana marang [[kongrès Amérikah Sarékat|kongrès]] gunggungé 7,1 yuta dollar kanggo miwiti implemèntasi rencana mau.<ref>[http://useu.usmission.gov/Article.asp?ID=D43D21FD-3D72-4780-BCDB-599EC56B12B3 Bush Outlines $7 Billion Pandemic Flu Preparedness Plan]{{dead link|date=August 2010}} US Mission to the EU, Diaksès 12 Dhésèmber 2009 {{Wayback|url=http://useu.usmission.gov/Article.asp?ID=D43D21FD-3D72-4780-BCDB-599EC56B12B3|date =20070807204025|bot=DASHBot}}{{dead link|date=August 2010}}</ref> Ing donya internasional, ing tanggal 18 Januari 2006, nagara-nagara danar wis janji kanggo nyumbang 2 yuta dolar kanggo merangi flu manuk ing Konferènsi Prajanjian Internasional ngenani influenza Unggas lan Manungsa ''(International Pledging Conference on Avian and Human Influenza)'' kang ditindakaké suwéné rong dina ing Cina.<ref>[http://www.ens-newswire.com/ens/jan2006/2006-01-18-02.asp Danar Nations Pledge $1.85 Billion to Combat Bird Flu] Newswire Diaksès 26 Oktober 2006.</ref> Sajeroning pambijian pandemi H1N1 2009 ing nagara-nagara kapilih ing wilahan bumi pérangan kidul, data nuduhaké yèn kabèh nagara ngalami dampak sosio/ékanami sajeroning wates wektu lan/utawa géografis tartamtu lan pamudhunan sauntara sajeroning kapariwisataan kang mligi disababaké déning kewedèn bakal lelara H1N1 2009. Isih awal banget kanggo nemtokaké apa pandemi H1N1 wis nimbulaké dampak ékanami jangka dawa.<ref>Assessment of the 2009 influenza A (H1N1) Outbreak on Selected Countries in the Southern Hemisphere. 2009. http://flu.gov/professional/global/southhemisphere.html</ref> == Panalitèn == [[Gambar:Influenza virus research.jpg|thumb|left|upright|200px|Dr. Terrence Tumpey mriksa virus [[flu Spanyol]] 1918.]] Panalitèn ing influenza nyakup panalitèn ing [[virologi molekulèr]], kepriyé virus nimbulaké lelara ([[patogenesis]]), [[rèspon imun]] inang, génom virus, lan kepriyé panyebaran virus ([[epidemiologi]]). Panalitèn iki mbiyantu pangembangan laku nangkal influenza; contoné, pamahaman kang luwih becik ngenani rèspons sistem imun awak mbiyantu pangembangan vaksin, lan gambaran kang dhetil ngenani kepriyé influenza nyerang sèl mbiyantu dikembangaké obat-obat antivirus. Salah siji program panalitèn dhasar kang paling wigati ya iku ''Influenza Genome Sequencing Project'' (Proyèk panemton urutan génom influenza), kang nyiptakaké pustaka (pratélan kumpulan) sékuèns (gèn) influenza; pustaka iki bisa mbiyantu nemtokaké faktor endi kang gawé sawijining galur luwih matèkaké tinimbang galur liyané, gèn endi kang paling mangaruhi [[imunogenisitas]], lan kepriyé virus évolusi saka wektu menyang wektu sabanjuré.<ref>[https://web.archive.org/web/20061108045050/http://msc.tigr.org/infl_a_virus/index.shtml Influenza A Virus Genome Project] at The Institute of Genomic Research. Diaksès 19 Oktober 2006</ref> Panalitèn vaksin anyar wigati banget, amarga vaksin kang sumadiya saiki alon banget lan larang kanggo diprodhuksi lan kudu diformulasi ulang saben tauné. Panemton urutan (sequencing) saka génom influenza lan tèknologi [[DNA rékombinan]] bisa nyepetaké tinemu galur vaksin anyar kanthi mungkinaké panaliti ngganti antigèn anyar ing galur vaksin kang wis dikembangaké sadurungé.<ref>{{cite journal |author=Subbarao K, Katz J |title=Influenza vaccines generated by reverse genetics |journal=Curr Top Microbiol Immunol |volume=283 |issue=|pages=313–42 |year=2004|pmid=15298174}}</ref> Tèknologi anyar uga nembé dikembangaké kanggo nuwuhaké virus ing kultur sèl, kang njanjèkaké angka prodhuksi kang luwih dhuwur, béya kang luwih asor, kualitas kang luwih apik lan ''surge capacity'' kang luwih apik.<ref>{{cite journal |author=Bardiya N, Bae J |title=Influenza vaccines: recent advances in production technologies |url=http://www.springerlink.com/content/jdt26gc39v4bwk9q/ |journal=Appl Microbiol Biotechnol |volume=67 |issue=3 |pages=299–305 |year=2005 |pmid=15660212 | doi=10.1007/s00253-004-1874-1}}</ref> Panalitèn ing vaksin influenza A universal, kang dituduhaké ing domain èksternal saka [[protéin M2]] transmémbran virus (M2e), nembé ditindakaké déning [[University of Ghent]] déning [[Walter Fiers]], [[Xavier Saelens]], lan klompoké<ref>{{cite journal |author=Neirynck S, Deroo T, Saelens X, Vanlandschoot P, Jou WM, Fiers W |title=A universal influenza A vaccine based on the extracellular domain of the M2 protéin |journal=Nat. Med. |volume=5 |issue=10 |pages=1157–63 |year=1999 |month=October |pmid=10502819 |doi=10.1038/13484 }} </ref><ref>{{cite journal |author=Fiers W, Neirynck S, Deroo T, Saelens X, Jou WM |title=Soluble recombinant influenza vaccines |journal=Philos. Trans. R. Soc. Lond., B, Biol. Sci. |volume=356 |issue=1416 |pages=1961–3 |year=2001 |month=December |pmid=11779398 |pmc=1088575 |doi=10.1098/rstb.2001.0980 }}</ref><ref>{{cite journal |author=Fiers W, De Filette M, Birkett A, Neirynck S, Min Jou W |title=A "universal" human influenza A vaccine |journal=Virus Res. |volume=103 |issue=1-2 |pages=173–6 |year=2004 |month=July |pmid=15163506 |doi=10.1016/j.virusres.2004.02.030 }}</ref> lan saiki wis kasil ngliwati uji klinis fase 1. Sapérangan ''[[biologic]]'', vaksin lan ''imunobiologic'' terapeutik uga nembé ditliti kanggo nambani infèksi kang disebabaké déning virus. Biologi terapeutik dirancang kanggo ngaktivasi rèspon imun tumrap virus utawa antigèn. Lumrahé ''biologic'' ora nargètaké [[jalur métabolik]] kaya déné obat-obat antivirus, nanging ngrangsang sèl imun kaya déné [[limfosit]], [[makrofag]], lan/utawa ''[[antigen presenting cells]]'' kanggo mènèhi rèspon imun tumrap èfèk [[sitotoksik]] marang virus. Modhèl influenza, kaya déné influenza mencit (''murine influenza'') wujud modhèl kang apik kanggo dipigunakaké kanggo nguji èfèk ''biologic'' profilaksis lan terapeutik. Contoné ''[[Lymphocyte T-Cell Immune Modulator]]'' nyandhet patuwuhan virus ing modhèl influenza mencit.<ref>{{cite journal |year=2008 |title=Lymphocyte T-Cell Immunomodulator: Review of the ImmunoPharmacology of a new Veterinary Biologic |journal=Journal of Applied Research in Veterinary Medicine |volume=6 |issue=2 |pages=61–68 | url=http://jarvm.com/articles/Vol6Iss2/Vol6Iss2Gingerich61-68.pdf |format=PDF | accessdate=5 December 2010 |DUPLICATE DATA: accessdate=2009-04-26 |author=Gingerich, DA}}</ref> == Infèksi ing kéwan liya == Influenza nginfèksi akèh spésiès [[kéwan]], lan transfer galur virus antar spésiès bisa dumadi. Unggas dinuga wujud inang kéwan utama saka virus influenza.<ref>{{cite journal |author=Gorman O, Bean W, Kawaoka Y, Webster R |title=Evolution of the nucleoprotein gene of influenza A virus |pmc=249282 |journal=J Virol |volume=64 |issue=4 |pages=1487–97 |year=1990 |pmid=2319644}}</ref> Nembelas wangun [[hémagglutinin]] lan sanga wangun [[néuraminidase]] wis diidhèntifikasi. Kabèh subtipe kang wis dikawruhi (HxNy) tinemu ing unggas, nanging akèh subtipe endemik ing [[manungsa]], [[asu]], [[jaran]], lan [[babi]]; populasi [[onta]], [[garangan]], [[kucing]], [[asu laut]], cerpelai (mink) lan [[iwak lodan]] uga nuduhaké bukti-bukti infèksi utawa paparan tumrap influenza.<ref name=webster/> Varian saka virus flu sok-sok dijenengi miturut spésiès ing endi galur mau endemik utawa adhaptasi. Varian utama saka jeneng-jeneng kang migunakaké konvènsi iki ya iku: flu unggas, flu manungsa, flu babi, [[flu jaran]], lan [[flu asu]]. ([[Flu kucing]] lumrahé ngrujuk marang [[rhinotracheitis virus kucing]] utawa ''[[Feline calicivirus]]'' lan dudu wujud infèksi kang asalé saka virus influenza.). Ing babi, jaran, lan asu, tandha-tandha influenza sarupa karo ing manungsa, mawa watuk, mriyang, lan [[anoreksia|kéhalangan nepsu mangan]].<ref name=webster/> Frékuènsi lelara iki ing kéwan ora disinaoni padha apiké ing infèksi marang manungsa, nanging wabah influenza ing asu laut pelabuhan nimbulaké kurang luwih 500 patiné asu laut ing pasisir [[New England]] nalika taun 1979-1980.<ref>{{cite journal |author=Hinshaw V, Bean W, Webster R, Rehg J, Fiorelli P, Early G, Geraci J, St Aubin D |title=Are seals frequently infected with avian influenza viruses? |pmc=255856 |journal=J Virol |volume=51 |issue=3 |pages=863–5 |year=1984 |pmid=6471169}}</ref> Ing sisih liya, wabah ing babi asring dumadi lan ora nimbulaké angka pepati kang abot.<ref name=webster/> === Flu unggas === Tandha-tandha flu ing unggas manéka lan mungkin ora spésifik.<ref>{{cite journal |author=Elbers A, Koch G, Bouma A |title=Performance of clinical signs in poultry for the detection of outbreaks during the avian influenza A (H7N7) epidemic in The Netherlands in 2003 |journal=Avian Pathol |volume=34 |issue=3 |pages=181–7 |year=2005 |pmid=16191700 | doi=10.1080/03079450500096497}}</ref> Tandha-tandha kang ngetutaké infèksi flu unggas kanthi patogenesitas kang asor bisa wujud wulu kang morak-marik, pamudhunan cilik sajeroning prodhuksi endhog, utawa pamudhunan bobot awak dikombinasikaké karo [[lelara ambegan]] ènthèng.<ref>{{cite book | last1=Capua| first1= I |last2= Mutinelli | first2= F. |chapter=Low pathogenicity (LPAI) and highly pathogenic (HPAI) avian influenza in turkeys and chicken | title=A Colour Atlas and Text on Avian Influenza |publisher= Papi Editore |location= Bologna |year= 2001 |pages=13–20 | isbn=88-88369-00-7 | url=http://books.google.com/books?id=S1hEAAAACAAJ }}</ref> Amarga tandha-tandha kang ènthèng iki bisa gawé diagnosis ing lapangan dadi angèl, ngetutaké panyebaran flu unggas merlokaké uji laboratorium saka sampel kang asalé saka unggas kang kainfèksi. Sapérangan galur kaya déné [[H9N2]] Asia virulèn banget marang kéwan ingon unggas lan bisa nimbulaké tandha-tandha kang luwih èkstrém lan mortalitas kang signifikan.<ref>{{cite journal |author=Bano S, Naeem K, Malik S |title=Evaluation of pathogenic potential of avian influenza virus serotype H9N2 in chickens |journal=Avian Dis |volume=47 |issue=3 Suppl |pages=817–22 |year=2003 |pmid=14575070 |doi=10.1637/0005-2086-47.s3.817}}</ref> Ing wangun kang paling patogenik, influenza ing [[pitik]] lan [[kalkun]] nimbulaké munculé tandha-tandha ndadak lan pepati mèh 100% sajeroning rong dina.<ref>{{cite journal |author=Swayne D, Suarez D |title=Highly pathogenic avian influenza |journal=Rev Sci Tech |volume=19 |issue=2 |pages=463–82 |year=2000 |pmid=10935274}}</ref> Amarga virus nyebar kanthi rikat ing kaanan kang padhet kaya déné ing paternakan intènsif pitik lan kalkun, wabah iki bisa nimbulaké dampak [[ékanami]] kang gedhé kanggo paternak unggas. Galur H5N1 kang wis adhaptasi marang unggas lan patogèn banget (diarani HPAI A(H5N1), cekakan saka "''highly pathogenic avian influenza virus of type A of subtype H5N1''") nimbulaké flu H5N1, kang lumrahé ditepungi minangka flu unggas, utawa "flu manuk", lan endemik ing akèh populasi manuk, mligi ing [[Asia Kidul-wétan]]. Galur turunan Asia saka HPAI A (H5N1) nyebar kanthi global. Epizootik (epidemi ing makluk urip dudu manungsa) lan panzootik (lelara kang ngenani kéwan saka akèh spésiès, mligi sajeroning wewengkon kang wiyar banget), wis matèni puluhan yuta unggas lan njalari pepati disengaja atusan yuta unggas liya sajeroning upaya kanggo ngendhalèkaké panyebarané. Sapérangan gedhé réferènsi ing médhia marang “flu manuk” lan sapérangan gedhé réferènsi marang H5N1 ya iku ngenani galur spésifik iki.<ref>{{cite journal |author=Li K, Guan Y, Wang J, Smith G, Xu K, Duan L, Rahardjo A, Puthavathana P, Buranathai C, Nguyen T, Estoepangestie A, Chaisingh A, Auewarakul P, Long H, Hanh N, Webby R, Poon L, Chen H, Shortridge K, Yuen K, Webster R, Peiris J |title=Genesis of a highly pathogenic and potentially pandemic H5N1 influenza virus in eastern Asia |journal=Nature |volume=430 |issue=6996 |pages=209–13 |year=2004 |pmid=15241415 | doi=10.1038/nature02746}}</ref><ref>Li KS, Guan Y, Wang J, Smith GJ, Xu KM, Duan L, Rahardjo AP, Puthavathana P, Buranathai C, Nguyen TD, Estoepangestie AT, Chaisingh A, Auewarakul P, Long HT, Hanh NT, Webby RJ, Poon LL, Chen H, Shortridge KF, Yuen KY, Webster RG, Peiris JS. [http://www.nap.edu/books/0309095042/html/116.html "The Threat of Pandemic Influenza: Are We Ready?" Workshop Summary] The National Academies Press (2005) "Today's Pandemic Threat: Genesis of a Highly Pathogenic and Potentially Pandemic H5N1 Influenza Virus in Eastern Asia", pages 116–130</ref> Saiki, HPAI A(H5N1) wujud lelara unggas, lan ora ana bukti kang nuduhaké panularan kang èfisièn manungsa-marang-manungsa saka HPAI A(H5N1). Ing mèh kabèh kasus, wong-wong kang kainfèksi wis ngalami kontak fisik kang èkstènsif karo unggas kang kainfèksi.<ref>{{cite journal |author=Liu J |title=Avian influenza—a pandemic waiting to happen? |url=http://jmii.org/content/pdf/v39n1p4.pdf |journal=J Microbiol Immunol Infect |volume=39 |issue=1 |pages=4–10 |year=2006 |pmid=16440117|format=PDF}}</ref> Ing mangsa ngarep, H5N1 bisa mutasi utawa ngalami réassortment dadi galur kang mampu ditularaké antar manungsa kanthi èfisièn. Owah-owahan kang diperlokaké nganti iki dumadi durung dikawruhi kanthi becik.<ref>{{cite journal |author=Salomon R, Webster RG |title=The influenza virus enigma |journal=Cell |volume=136 |issue=3 |pages=402–10 |year=2009 |month=February |pmid=19203576 |pmc=2971533 |doi=10.1016/j.cell.2009.01.029}}</ref> Nanging, amarga dhuwuré angka pepati lan virulènsi H5N1, kaanan endemiknya, lan inang réservoir biologis kang gunggungé gedhé lan tansaya tambah, virus H5N1 wujud ancaman pandemi donya ing mangsa flu taun 2006-07, lan milyaran dolar wis diklumpukaké lan dientèkaké sajeroning nliti H5N1 lan ngrencanakaké kanggo kamungkinan pandemi influenza.<ref name=Rosenthal>{{cite news | last1=Rosenthal |first1= E. |last2= Bradsher |first2= K. |url=http://www.nytimes.com/2006/03/16/business/16bird.html?_r=1&oref=slogin | title= Is Business Ready for a Flu Pandemic? |work= The New York Times |date=16 March 2006 |accessdate= 17 April 2006 }}</ref> === Flu babi === Ing [[babi]], influenza babi nimbulaké mriyang, awak lemes, wahing, watuk, kangèlan ambegan, lan pemudhunan nepsu mangan.<ref name=Kothalawala>{{cite journal |author=Kothalawala H, Toussaint MJ, Gruys E |title=An overview of swine influenza |journal=Vet Q |volume=28 |issue=2 |pages=46–53 |year=2006 |month=June |pmid=16841566}}</ref> Ing sapérangan kasus infèksi bisa nimbulaké aborsi. Sanajan mortalitas lumrahé asor, virus bisa nimbulaké pamudhunan bobot awak lan patuwuhan kang ala, nimbulaké dampak karugèn ékanami kanggo para paternak.<ref name=Kothalawala/> Babi kang kainfèksi bisa ngalami kélangan bobot watara 12 pon bobot awak sajeroning jangka wektu 3 nganti 4 minggu.<ref name=Myers>{{cite journal |author=Myers KP, Olsen CW, Gray GC |title=Cases of swine influenza in humans: a review of the literature |journal=Clin. Infect. Dis. |volume=44 |issue=8 |pages=1084–8 |year=2007 |month=April |pmid=17366454 |pmc=1973337 |doi=10.1086/512813 }}</ref> Nalika taun 2009, galur virus [[H1N1]] kang asalé saka babi, kang asring diarani “flu babi” njalari pandemi flu 2009, nanging ora ana bukti yèn virus iki èndemik ing babi (temenan wujud flu babi) utawa bisa nular saka babi menyang manungsa, nanging virus iki nyebar saka manungsa-marang-manungsa.<ref>{{cite web|url=http://www.oie.int/eng/press/en_090427.htm|title=Press Release: A/H1N1 influenza like human illness in Mexico and the USA: OIE statement|author=Maria Zampaglione |publisher=[[World Organisation for Animal Health]] |date=April 29, 2009 |accessdate=April 29, 2009|archiveurl=http://web.archive.org/20090430105521/www.oie.int/eng/press/en_090427.htm|archivedate=April 30, 2009}}</ref><ref>{{cite news |url=http://www.nytimes.com/2009/05/01/health/01name.html?scp=5&sq=&st=nyt |title=W.H.O. Gives Swine Flu a Less Loaded, More Scientific Name | work=The New York Times | first=Denise | last=Grady | date=2009-05-01 | accessdate=2010-03-31}}</ref> Galur iki wujud réassortment saka sapérangan galur H1N1 kang lumrahé tinemu kanthi kapisah, ing manungsa, unggas, lan babi.<ref>{{cite news |url=http://www.nytimes.com/2009/05/01/health/01origin.html?scp=2&sq=&st=nyt |title=Virus's Tangled Genes Straddle Continents, Raising a Mystery About Its Origins |format=| work=The New York Times | first=Donald G. | last=McNeil Jr. | date=2009-05-01 | accessdate=2010-03-31}}</ref> == Cathetan sikil == {{reflist|2}} <!-- {{Reflist|colwidth=30em}} --> == Wacan terusan == {{Col-begin}} {{Col-1-of-2}} '''Umum''' {{Refbegin}} * {{cite journal |author=Beigel JH, Farrar J, Han AM, ''et al.'' |title=Avian influenza A (H5N1) infection in humans |journal=N Engl J Med. |volume=353 |issue=13 |pages=1374–85 |year=2005 |month=September |pmid=16192482 |doi=10.1056/NEJMra052211 |url=http://content.nejm.org/cgi/content/full/353/13/1374}} * Bernd Sebastian Kamps, Christian Hoffmann and Wolfgang Preiser (Eds.) 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Dis. |volume=12 |issue=1 |pages=34–9 |year=2006 |month=January |pmid=16494714 |url=http://www.cdc.gov/ncidod/EID/vol12no01/05-1013.htm}} * {{cite journal |author=Horimoto T, Kawaoka Y |title=Pandemic threat posed by avian influenza A viruses |journal=Clin Microbiol Rev. |volume=14 |issue=1 |pages=129–49 |year=2001 |month=January |pmid=11148006 |pmc=88966 |doi=10.1128/CMR.14.1.129-149.2001}} * [http://www.who.int/wer/wer8126.pdf Epidemiology of WHO-confirmed human cases of avian influenza A(H5N1) infection] {{Refend}} '''Pananganan lan panyegahan''' {{Refbegin}} * {{cite journal |author=Harper SA, Fukuda K, Uyeki TM, Cox NJ, Bridges CB |title=Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP) |journal=MMWR Recomm Rep |volume=54 |issue=RR-8 |pages=1–40 |year=2005 |month=July |pmid=16086456}} * {{cite journal |author=Monto AS |title=Vaccines and antiviral drugs in pandemic preparedness |journal=Emerging Infect. Dis. |volume=12 |issue=1 |pages=55–60 |year=2006 |month=January |pmid=16494718 |url=http://www.cdc.gov/ncidod/EID/vol12no01/05-1068.htm}} {{Refend}} '''Panelitèn''' {{Refbegin}} * {{cite journal |author=Palese P |title=Making better influenza virus vaccines? |journal=Emerging Infect. Dis. |volume=12 |issue=1 |pages=61–5 |year=2006 |month=January |pmid=16494719 |url=http://www.cdc.gov/ncidod/EID/vol12no01/05-1043.htm}} * [https://web.archive.org/web/20060824004040/http://www.who.int/csr/disease/avian_influenza/guidelines/recommendationvaccine.pdf WHO (PDF) contains latest Evolutionary "Tree of Life" for H5N1] article ''Antigenic and genetic characteristics of H5N1 viruses and candidate H5N1 vaccine viruses developed for potential use as pre-pandemic vaccines'' published 18 August 2006 * [http://www.who.int/csr/resources/publications/influenza/WHO_CDS_EPR_GIP_2006_3C.pdf WHO's assessment of Flu Research] as of November 2006. {{Refend}} {{Col-end}} == Pranala njaba == {{sisterlinks}} {{Refbegin}} * [http://www.ers-education.org/pages/default.aspx?id=331 ERS Online Course on Influenza] * [https://web.archive.org/web/20110727105753/http://www.myfamilywellness.org/MainMenuCategories/FamilyHealthCenter/Flu.aspx Swine and Seasonal Flu], [http://www.goodmedicine.org/ Institute for Good Medicine] at the [http://www.pamedsoc.org/ Pennsylvania Medical Society] * [https://web.archive.org/web/20150224111616/https://www.ruqyahcirebon.com/ Ruqyah Cirebon] at [[Centers for Disease Control and Prevention|CDC]] * [http://health.nytimes.com/health/guides/disease/the-flu/overview.html Summary of the disease] at the [[NYTimes]]. * [http://www.nytimes.com/2009/05/05/health/05virus.html 10 Genes, Furiously Evolving] [[NYTimes]] May 2009 * [http://www.outbreakalerts.com/ Outbreak Alerts] United States based communicable disease notification website * [http://www.mayoclinic.com/health/influenza/DS00081 Influenza (Mayo Clinic)] * [http://www.who.int/mediacentre/factsheets/fs211/en/index.html Fact Sheet] Overview of influenza at World Health Organization * [http://origem.info/misms/index.php The Multinational Influenza Seasonal Mortality Study (MISMS)] [[Fogarty International Center]] * [http://www.ncbi.nlm.nih.gov/genomes/FLU/flubiology.html Influenza Virus Resource] from the [[National Center for Biotechnology Information|NCBI]] * [http://www.eiss.org/ European Influenza Surveillance Scheme] * [http://www.google.org/flutrends/ Flu Trends] – flu activity across the U.S. * [https://www.nhsdirect.nhs.uk/Sat/Topics/ColdsAndFlu.aspx?Host=Nhsd&SyndicationPartnerGuid=d19370ea-a100-407d-9695-b73407f701c7&TopicGuid=8c903315-a302-412a-bfae-9cb576d4b4cd Cold and flu advice] (NHS Direct) * [http://www.vega.org.uk/video/programme/6 Online video discussing influenza outbreaks and spread of other infectious diseases] (Vega Science Trust) * [http://www.pandemicflu.gov/ Flu.gov: Know What To Do About the Flu] * [http://www.path.org/vaccineresources/influenza.php PATH Vaccine Resource Library influenza resources] * [http://www.fludb.org/ Influenza Research Database] – Database of influenza genomic sequences, serotypes, polymorphisms, structures, epitopes, drugs and related tools. * [http://www.recombinomics.com/whats_new.html? Recombinomics - What's New]: Up to date details of circulating strains. {{Refend}} {{artikel pilihan}} [[Kategori:Influenza| ]] [[Kategori:Lelara nular]] [[Kategori:Pulmanalogi]] [[Kategori:Lelara ambegan]] eg6hozgefyox7vm3x2yso2p3o1vlyoj