What is the difference between H1N1 and H3N2?
Indmedica
Introduction
Influenza, commonly referred to as the flu, is a highly contagious viral infection that affects the respiratory system. The flu virus is constantly evolving, leading to new strains that can cause different symptoms and have varying degrees of severity. Influenza A viruses are classified based on the combination of two proteins on their surface, hemagglutinin (H) and neuraminidase (N). H1N1 and H3N2 are two subtypes of Influenza A that have caused significant outbreaks in the past. In this article, we will discuss the key differences between H1N1 and H3N2 and their implications for healthcare professionals.
Transmission and Symptoms
Both H1N1 and H3N2 are transmitted from person to person through respiratory droplets when an infected person coughs or sneezes. The symptoms of H1N1 and H3N2 are similar and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. In severe cases, both viruses can cause pneumonia, respiratory failure, and death.
However, H1N1 is associated with more severe symptoms in young adults, pregnant women, and individuals with underlying medical conditions such as asthma, diabetes, or heart disease. During the 2009 H1N1 pandemic, younger people were more likely to be affected than older adults because older adults may have had previous exposure to similar H1N1 viruses that circulated in the past.
On the other hand, H3N2 is typically more severe in older adults, especially those over 65 years of age. This is because H3N2 has been circulating since the 1960s and older adults may have some immunity to previous strains of H3N2. However, H3N2 can also cause severe illness in young children, pregnant women, and individuals with underlying medical conditions.
Vaccination
The flu vaccine is the most effective way to prevent influenza and its complications. The flu vaccine is formulated each year based on the strains that are expected to circulate during the upcoming flu season. The vaccine contains either inactivated or weakened forms of the flu virus that stimulate the immune system to produce antibodies against the virus.
The H1N1 strain is included in the seasonal flu vaccine each year. The 2009 H1N1 pandemic led to the development of a separate vaccine that specifically targets the H1N1 virus. The H1N1 vaccine is recommended for all individuals, particularly those at higher risk of severe illness such as pregnant women, young children, and people with underlying medical conditions.
The H3N2 strain is also included in the seasonal flu vaccine each year. However, the effectiveness of the vaccine against H3N2 can vary from year to year due to antigenic drift, which is a gradual change in the viral surface proteins that allows the virus to evade the immune system. In some years, the vaccine may be less effective against H3N2, leading to more cases of the flu and higher rates of hospitalization and death.
Treatment
Antiviral medications are available to treat both H1N1 and H3N2 influenza infections. The two main classes of antiviral medications for influenza are neuraminidase inhibitors (NAIs) and adamantanes.
Neuraminidase inhibitors (NAIs), such as oseltamivir and zanamivir, are effective against both H1N1 and H3N2. They work by blocking the activity of the neuraminidase protein, which is necessary for the virus to spread from infected cells to healthy cells. NAIs can reduce the severity and duration of symptoms, shorten the duration of viral shedding, and prevent complications such as pneumonia. Treatment with NAIs is recommended for individuals who are at high risk of complications from the flu, such as older adults, young children, pregnant women, and people with underlying medical conditions.
Adamantanes, such as amantadine and rimantadine, are only effective against some strains of H1N1 and are not recommended for the treatment of H3N2. They work by blocking the activity of the M2 protein, which is necessary for the virus to enter healthy cells. However, the use of adamantanes is limited due to the emergence of drug-resistant strains of the virus. In fact, the Centers for Disease Control and Prevention (CDC) currently recommends against the use of adamantanes for the treatment or prophylaxis of influenza due to widespread resistance.
It is important to note that antiviral medications are most effective when given early in the course of the illness, ideally within 48 hours of symptom onset. Therefore, prompt diagnosis and treatment are essential. Additionally, antiviral medications are not a substitute for vaccination, which remains the most effective way to prevent influenza and its complications.
References and additional reading
https://pubmed.ncbi.nlm.nih.gov/21992699/
https://pubmed.ncbi.nlm.nih.gov/31036119/
https://www.dovepress.com/clinical-differences-between-h3n2-and-h1n1-influenza-2012-and-lower-re-peer-reviewed-fulltext-article-TCRM
https://erj.ersjournals.com/content/46/suppl_59/PA2608
