New swine flu virus infects four people at U.S. county fair

[CanadaSue]

Same H3N2 swine strain that's infected a total, (to date), of 17 people - all in the US. No sign of H-H & unclear of what the potentials are.

County fair season is starting up - don't get too close to the swine & pay close attention to hyguene if you do... especially with your kids.


http://www.thestar.com/news/world/ar...-s-county-fair

[Kassy]

Published Date: 2012-07-26 18:14:49
Subject: PRO/AH/EDR> Influenza (58) - USA: (IN) A(H3N2)v cases, CDC
Archive Number: 20120726.1216502

INFLUENZA (58) - UNITED STATES OF AMERICA: (INDIANA) A(H3N2)V, CDC
************************************************** ****************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: 26 Jul 2012

Source: CDC [edited]

http://www.cdc.gov/mmwr/preview/mmwr...cid=mm6129a5_w





Outbreak of Influenza A (H3N2) Virus Among Persons and Swine at a County Fair


-----------------------------------------------------------------------------


During 12-16 Jul 2012, the Indiana State Department of Health and the Indiana Board of Animal Health identified respiratory illness among swine and persons at a county fair held 8-14 Jul 2012. On 16 Jul 2012, specimens were collected from 4 persons with respiratory illness; 2 had become ill on 12 Jul 2012 and sought care at an emergency department, and 2 were identified as part of the subsequent public health investigation. All 4 persons were swine exhibitors or family members of swine exhibitors and had close contact with swine.



On 18 Jul 2012, reverse transcription-polymerase chain reaction (RT-PCR) testing at the Indiana State Department of Health laboratory identified suspected influenza A (H3N2) variant (H3N2v) virus in all 4 specimens. On 21 Jul 2012, partial genome sequencing at CDC confirmed H3N2v virus with the influenza A (H1N1)pdm09 virus M gene; the viruses detected in the 4 specimens are similar to 12 viruses detected in 2011 and one detected earlier this year (1). None of the 4 persons were hospitalized, and all have fully recovered. [See also ProMED-mail archived report: Influenza (57) - USA: (IN) A(H3N2)v cases 20120725.1214922].



Additionally, all respiratory specimens collected from a sample of 12 swine at the fair were positive for influenza A (H3N2) virus. The specimens were forwarded to the National Veterinary Services Laboratories of the U.S. Department of Agriculture for additional testing. Preliminary genetic analysis has shown a very high level of similarity between the gene sequences of H3N2v viruses from humans and the H3N2 viruses from swine.



Although human-to-human transmission of H3N2v has been limited in previous outbreaks (1), these viruses could change to transmit efficiently among humans. Clinicians who suspect influenza in persons with recent exposure to swine should obtain a nasopharyngeal swab or aspirate from the patient, place the swab or aspirate in viral transport medium, and contact their state or local health department to arrange transport and request a timely diagnosis at a state public health laboratory (1). Clinicians should consider antiviral treatment with oral oseltamivir or inhaled zanamivir in suspected cases (2).



Persons who raise swine or come into close contact with swine at fairs or other venues should be aware of the potential risk for influenza transmission between swine and humans. To reduce this risk, preventive measures such as practicing frequent hand hygiene and respiratory etiquette are recommended. Persons also should avoid close contact with animals that look or act ill, when possible, and if experiencing influenza-like illness themselves, should avoid contact with swine. Additional guidelines on prevention of influenza transmission between humans and swine are available at http://www.cdc.gov/flu/swineflu/industry_guidance.htm.



Including the cases in this report, 17 infections with H3N2v virus with the influenza A (H1N1)pdm09 virus M gene have been reported since August 2011. Novel influenza A virus infection in humans is a nationally notifiable disease (3) and a reportable disease under International Health Regulations (4). State public health laboratories should contact CDC and send all suspected novel influenza A specimens for confirmatory testing. Additional information about H3N2v is available at: http://www.cdc.gov/flu/swineflu/infl...uses-h3n2v.htm.



References:


-----------


(1) CDC. Update: influenza A (H3N2)v transmission and guidelines--five states, 2011. MMWR 2012;60:1741-4.

(2) CDC. Antiviral agents for the treatment and chemoprophylaxis of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60(No. RR-1).

(3) Council of State and Territorial Epidemiologists. National reporting for initial detections of novel influenza A viruses. Position statement 07-ID01. Atlanta, GA: Council of State and Territorial Epidemiologists; 2007. Available at http://www.cste.org/ps/2007ps/2007ps...d/07-id-01.pdf. Accessed 24 Jul 2012.



--

Communicated by:

ProMED-mail

<promed@promedmail.org>

[Influenza viruses that circulate in swine are called swine influenza viruses when isolated from swine, but are called variant viruses when isolated from humans. A variant virus (human isolate) might or might not have the M gene from the influenza A (H1N1)pdm09 virus, along with other genetic changes. Seasonal influenza A (H3N2) viruses that circulate worldwide in the human population have significant antigenic and genetic differences from influenza A (H3N2) viruses circulating in swine. Additional information available at http://www.who.int/influenza/gisrs_l.../en/index.html.



The interactive HealthMap of Indiana can be accessed at: http://healthmap.org/r/2qty. - Mod.CP]




See Also

Influenza (57) - USA: (IN) A(H3N2)v cases 20120725.1214922
Influenza (43): Cambodia, H1N1, H3N2, porcine ex human 20120601.1152800
Influenza (36): Norway, H3N2v seroprevalence 20120511.11301812011
Influenza (29): H3N2v cross-reactive antibodies 20120412.1099325
Influenza (28): USA (UT) H3N2v isolation 20120412.1098447
Influenza (26): H3N2 surveillance Canada (BC), USA 20120408.1093983
Influenza (25): H3N2v, pathogenesis & transmission 20120407.1093271
2011
----
Influenza (77): WHO update 20111216.3614
Influenza (76): USA, two novel influenza A viruses 20111210.3563
Influenza (75): USA update 20111208.3553
Influenza (74): swine-origin H3N2 reassortant, vaccine candidate 20111203.3526
Influenza (73): WHO update 20111202.3519
Influenza (72): Europe, swine-origin H3N2 reassortant, risk assessment 20111130.3494
Influenza (71): USA (IA) swine-origin H3N2 reassortant, WHO 20111125.3448
Influenza (70): USA (IA) swine-origin H3N2 reassortant 20111124.3438
Influenza (69): USA (IA) swine-origin H3N2 reassortant 20111123.3430
Influenza (68): Hong Kong swine-origin H3N2 reassortant 20111119.3411
Influenza (67): WHO update 20111118.3403
Influenza (66): USA swine-origin H3N2 reassortant, update 20111105.3298
Influenza (64): WHO update 20111104.3289
Influenza (63): USA (ME, NOT NH) corr. 20111106.3307
Influenza (63): USA (ME, NOT NH) swine-origin H3N2 reassortant 20111102.3260
Influenza (61): WHO update 20111021.3140
Influenza (60): USA (ME) swine-origin H3N2 reassortant 20111021.3134
Influenza (58): WHO update 20111007.3019]]
.................................................c p/ejp/jw

http://www.promedmail.org/direct.php...120726.1216502

[Malcolm]

Great............ thats what we need.

[Kassy]

A bit of analysis on the human sequences:

Evolution of a Novel Human H3N2v Sub-clade
Recombinomics Commentary 12:55
July 31, 2012

This chart indicates the number of CDC-reported infections with variant influenza A viruses since August 2011. The following states have reported cases: Indiana (6), Iowa (3), Maine (2), Pennsylvania (3), Utah (1), and West Virginia (2).

The above comments are from the CDC page on H3N2v cases. It was created to tally H3N2v cases which have the H1N1pdm09 M gene, which was confirmed almost a year ago on a July case. Samples were collected on July 24 and July 27 and sequencing confirmed the novel constellation. However, the first H3N2v case in the United States was three years ago in a case linked to the Riley County Fair in Kansas (A/Kansas/13/2009), and the most recent reported cases in 2011 were linked to a Mineral County day care center, where two confirmed cases were identified (A/West Virginia/06/2011 and A/West Virginia/07/2011), and the N2 gene segment represented a distinct lineage (found in H3N2 swine). All subsequent human sequences reported to date have been this novel sub-clade, including the two sequences from the LaPorte County Fair in Indiana.

The first H3N2v case in the United States was reported after the start of the 2009 pandemic. Prior to the pandemic there had been 13 reported cases in the United States, and the only outbreak with two confirmed cases was in 2007 at the Heron County Fair in Ohio. Like the recent outbreak in Indiana, the confirmed cases had contact with swine (cases were a presenter and her father – A/Ohio/01/2007 and A/Ohio/02/2007).

The sequences from the two human cases were identical and matched H1N1v sequences from swine at the fair. In addition to the two confirmed cases, 26 fair attendees were symptomatic, but not tested. Flu-like symptoms in August in Ohio are uncommon, suggesting most or all of the symptomatic attendees were also infected with the H1N1v.

Although the first H3N2v case had an H3 which traced back to seasonal H3N2 circulating in the mid-1990’s and anN2 linking back to seasonal H3N2 from 2003, the internal genes were closely related to the sequences from the 2007 Heron County Fair. However, the PB1 in A/Kansas/13/2009 had acquired E618D, which was in all human and swine H1N1pdm09 sequences, but not present in swine sequences (other than H1N1pdm09). The first reported swine case was reported more than a year later, in the fall of 2010.

In addition to the first H3N2v case in 2009, E618D was present in all six human H3N2v PB1 sequence in 2010. Similarly, most of the other genes were present in most of the 2010 cases, but two of the cases, A/Wisconsin/12/2010 and A/Pennsylvania/40/2010 match each other in all 8 gene segments.

In 2011, the first case, A/Indiana/08/2011 had five gene segments (PB2, PA, HA, NP, NS) which matched the above two 2010 sequences, while the other three genes (PB1, NA. MP) matched 2010 sequences from H1N2 Ohio swine (A/swine/Ohio/FAH10-1/2010 as well as NA and MP from many additional H1N2 isolates for which only HA, NA and MP sequences were released). The PB1 was closely related to the Heron County Fair sequence, but did not have E618D. However, the MP was from H1N1pdm09, while the N2 was from a lineage common to H1N2 swine, but also traced back to seasonal H3N2 from 2003.

The constellation in Indiana/08/2011 was also present in the next 9 human cases (from Pennsylvania, Maine, Indiana, and Iowa). The common constellation in all 10 cases, including an H1N1pdm09 M gene led to the creation of the CDC H3N2v website.

However, the final two reported cases in 2011 represented a novel sub-clade, which replaced the N2 found in H1N2v swine with an N2 found in H3N2v swine. This novel sub-clade has also been seen in all three human sequences from 2012 (and presumably in the two additional cases from LaPorte as well as the 12 sequences from swine at the fair (which are in addition to the two earlier 2012 swine sequences with this novel constellation.

Although the MMWR on the West Virginia outbreak noted the gap between disease onset dates for the two confirmed cases and noted that additional contacts with the index case were symptomatic, the extent of the spread was not revealed. The two confirmed cases had no swine contact, but a CDC report distributed to all fifty states noted that 23 of 70 contacts with the index case were symptomatic, indicating the novel constellation was efficiently transmitting in humans.

Concerns regarding human adaptation were increased when the sequence from the first human case (A/Utah/10/2012) were released and matched the West Virginia cases. Although the case had swine contact at a family owned slaughter house, no symptomatic swine were reported and exposure was over a week prior to disease onset, casting doubt on the role of swine in the infection.

In contrast, the LaPorte County Fair outbreak in Indiana had symptomatic swine, and 12 of 12 swine were H3N2v positive (and testing included asymptomatic swine). The H3N2v testing supported efficient spread through the swine at the fair, and four presenters or family members were H3N2v confirmed, representing the largest number of confirmed H3N2v cases reported to date. However, comments from attendees indicated the number of symptomatic attendees was significantly higher than the four confirmed cases, and raised concerns that the H3N2v also transmitted efficiently in humans. The first two confirmed cases (13F and 11F) were from separate families, and at least two sisters of one of the cases (11F), as well as 3 swine, were symptomatic. Similarly, another attendee noted symptoms in four family members as well as additional adult cases, suggesting the demographics for the symptomatic cases in Indiana were different than the earlier cases which were almost exclusively in children under the age of 8.

The changing demographic parameters and the large number of symptomatic cases linked to the West Virginia and Indiana outbreaks raises concerns that H3N2v adaptation is increasing the efficiency of human transmission.

http://www.recombinomics.com/News/07...Evolution.html

[Exodia]

I think this is the first time they have been able to pin infected swine and infected humans in the same place.

[Kassy]

Ten Confirmed H3N2v Cases at Butler County Fair In Ohio
Recombinomics Commentary 17:45
August 1, 2012

Preliminary laboratory results on ten samples indicate similarities to the influenza virus, (H3N2)v. All individuals in Butler County’s investigation also had direct contact with swine, however the Centers for Disease Control and Prevention (CDC) have not yet confirmed any of the cases.

The above comments from today’s Butler County Health Department press release describe lab confirmation of H3N2v in 10 people associated with the Butler County Fair in Hamilton, Ohio. Positive samples are forwarded to the CDC for sequence confirmation.

All H3N2v human sequences since the outbreak at the West Virginia day care center in Nov/Dec, 2011 have been a novel H3N2v which has an N2 lineage commonly found in H3N2v swine, which is distinct from the first 10 H3N2v cases in 2011 which had an N2 matching swine H1N2.

Prior to the LaPorte outbreak in Indiana, only two swine H3N2 sequences matching recent human cases had been identified (A/swine/North Carolina/A01203272/2012 and A/swine/Indiana/A01203509/2012). Most recent swine isolates (other than the unpublished LaPorte isolates) have matched the constellation seen in the earlier 2011 cases. These matches included four June, 2012 isolates from Ohio.

However, 10 confirmed H3N2v cases from one venue would be a record, and the new novel sub-clade appears to be efficiently transmitting in humans (the West Virginia outbreak included 23 symptomatic contacts and none had a swine exposure) and swine 12/12 swine from the LaPorte fair with H3N2v confirmed, including asymptomatic swine.

The 10 lab confirmed Ohio cases are in addition to the 4 confirmed cases in LaPorte County Indiana, as well as Maui, Hawaii. Suspect cases have also been reported in Monroe and Jackson counties in central Ohio, which also suggests that the novel H3N2 is rapidly spreading in swine and people.

Sequence data on these recent confirmed and suspect cases in Indiana and Ohio would be useful.

http://www.recombinomics.com/News/08...Butler_10.html

Bolding mine. It could be increased efficiency or it could be something we didn't find last year because we didn't look for it then.

[Kassy]

Ohio investigating at least ten more:

http://www.newarkadvocate.com/articl...wine-flu-cases

And maybe more, 41 people with flu like illness connected to the fair:
http://www.courierpress.com/news/201...cases-studied/

[Sysiphus]

Didn't it hit in HI too?

[CanadaSue]

If you mean Hawaii, then yes:

***INFLUENZA (61): USA (HAWAII), A(H3N2)V, PIG WORKER
**************************************************

Date: Wed 1 Aug 2012
Source: Honolulu Star Advertiser [edited]
http://www.staradvertiser.com/s?acti...6&id=164553586


A Maui resident whose work involves contact with pigs contracted Hawaii's 1st confirmed case of an unusual swine flu strain that has been detected in only 6 mainland states in the past year, the state Health Department said Tuesday [31 Jul 2012]. The state Agriculture Department plans to take nasal swabs of a "couple" of pig herds on Maui looking for evidence of the H3N2v virus, said state veterinarian Dr. James Foppoli.

Since August 2011, the H3N2v virus has only been found in 17 patients on the mainland, according to the Centers for Disease Control and Prevention. "If we find an infected herd, our recommendation is to not move the animals to make sure there's no more transmission in the herd, and then they will be OK to go to slaughter once they're well," Foppoli said. "Human-to-human transmission is uncommon, so that's not a likely source. You've got to suspect that there's a pig intermediate somewhere along the line where the person got the virus."

The U.S. Centers for Disease Control and Prevention late last week confirmed Hawaii's 1st case of the H3N2v virus after the unidentified, adult Maui resident sought medical attention upon experiencing symptoms consistent with the regular seasonal flu, including fever, cough and body aches, the Health Department said. The patient has recovered fully and did not require hospitalization, the Health Department said.

Health officials recommend that people who have been in "close contact with pigs" consult with their health care providers if they come down with flu-like symptoms, said Health Department spokeswoman Judy Kern. She emphasized that "pork is safe to eat if properly cooked. There is no risk at all for properly cooked pork." State agriculture officials are encouraging Hawaii's swine producers to practice good hygiene, such as hand washing. In 2009, 13 people in Hawaii -- most of them on Oahu -- died after contracting the H1N1 "swine flu" virus that also sickened dozens of other patients.

Until the Maui case, the new H3N2v flu had been confirmed in Indiana (6 cases), Iowa (3), Maine (2), Pennsylvania (3), Utah (one) and West Virginia (2), according to the CDC. Hawaii health officials said the mainland cases occurred primarily in children and those who work closely with pigs. "The virus seems to be behaving as previously observed in other cases, with illness similar to seasonal flu and with no sustained community transmission," state epidemiologist Sarah Park said in a statement. "Still, anyone who develops flu-like illness within a week after close contact with domestic pigs should see their healthcare provider." Children, pregnant women, seniors and anyone with compromised immune systems should be particularly careful around pigs and practice good hand-washing habits, the Health Department said.

Because the Maui patient's primary care doctor participates in the Health Department's influenza like-illness sentinel network, a respiratory specimen was 1st sent to the state Laboratories Division for testing. "Fortunately, we have a robust surveillance network, and our state laboratory detected this variant virus and conferred with federal partners," Health Director Loretta Fuddy said in a statement. "Thanks to the excellent cooperation of Hawaii's health care providers, participation in our sentinel network exceeds CDC recommendations," Fuddy said. "In addition to our state laboratory's ability to identify unusual flu strains, sentinel physicians contribute to our ability to catch incidents such as this, which might otherwise fall below the radar."

[Byline: Dan Nakaso]

--
Communicated by:
David Duffy
Pacific Cooperative Studies Unit
Botany
University of Hawaii
3190 Maile Way
Honolulu Hawaii 96822 USA


[The number of known A(H3N2)v cases in the United States has now risen to 17 in the past year. Most of the other A(H3N2)v cases in the past year have occurred in children. The virus seems to be behaving as previously observed in other cases, causing illness similar to seasonal influenza and with no sustained community transmission.***


http://www.promedmail.org/?p=2400:1000

[Justathought]

August 3, update from Dr. Niman (Recombinomics): H to H, Swine to Swine, sustained since 2011. PANDEMIC...

Hawaii Match With Indiana and Ohio Signals H3N2v Pandemic

Recombinomics Commentary, August 3, 2012

The CDC has released a series of H3N2v sequences from the recently confirmed cases in Hawaii (A/Hawaii/03/2012), Ohio (A/Ohio/13/2012 from Butler County), and Indiana (A/Indiana/12/12 from Jackson County). Full or partial sequences were generated for all 8 gene segments by sequencing of the clinical sample. In additional partial sequences were generated for the two confirmed LaPorte County cases (A/Indiana/06/2012 and A/Indiana/08/2012) which were not cloned.

All of these sequences were closely related in all gene segments and matched the two earlier sequences from Laporte (A/Indiana/07/2012 and A/Indiana/09/2012) which were closely related to the sequences from the Mineral County daycare center (A/West Virginia/06/2011 and A/West Virginia/07/2011) which involved 23 symptomatic contacts and no swine exposure. These sequences were also related to the first cases in 2012, A/Utah/10/2012.

All human H3N2v cases since November 2011 represent a novel sub-clade that efficiently transmits in humans (H2H), as seen at the West Virginia daycare center, and swine (S2S as seen at the LaPorte County Fair where 12/12 swine were H3N2v confirmed). Thus, this novel sub-clade transmits H2H, S2S, H2S, and S2H leading to significant transmission at county fairs with swine, especially in areas like Jackson County, Indiana where there have been symptomatic human cases for the past 6 weeks.

The presence of the same novel sub-clade in all human cases since late 2011 indicates transmission is sustained, but poorly detected in cases without swine exposure.


http://www.recombinomics.com/News/08..._HI_IN_OH.html

Recombinomics Presentations

Recombinomics Publications

Recombinomics Paper at Nature Precedings

[Kassy]

Published Date: 2012-08-03 13:38:19
Subject: PRO/AH/EDR> Influenza (62): USA (OH) A/(H3N2)v, susp.
Archive Number: 20120803.1227435

INFLUENZA (62): USA (OHIO), A/(H3N2)V, SUSPECTED
*************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Wed 1 Aug 2012

Source: Central Ohio News 10tv.com, Associated Press report [edited]

http://www.10tv.com/content/stories/...swine-flu.html





Ohio health and agriculture officials are investigating 10 sick persons whose cases have similarities to a swine flu [viral illness]. All had attended a southern Ohio county fair.



State and Butler County health departments say preliminary laboratory tests indicate possible H3N2 variant flu virus [influenza A/(H2N3)v virus], which can be contracted by humans from being around infected hogs. Officials say all 10 had contact with hogs at the Butler County Fair, which ended last weekend. The U.S. Centers for Disease Control and Prevention is also investigating but hasn't confirmed swine flu.



Health officials say all 10 are recovering from their illness. Swine flu symptoms include cough, sore throat, fever and body aches.



Indiana authorities last week said they were investigating similar cases involving 4 people who had swine contact at a northwest Indiana fair.



--

Communicated by:

ProMED-mail from HealthMap alerts

<promed@promedmail.org>

[The number of confirmed A(H3N2)v cases in the United States has now risen to 17 in the past year. Most of the A(H3N2)v confirmed cases have been children who had some form of contact with swine, with the exception of an adult pig worker in Hawaii. Up to the present, this virus has not been detected outside of the United States. - Mod.CP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1BY2.]

http://www.promedmail.org/direct.php...120803.1227435

---------- Post added at 06:36 PM ---------- Previous post was at 06:35 PM ----------

Published Date: 2012-08-05 03:52:58
Subject: PRO/AH/EDR> Influenza (64): USA A/(H3N2)v CDC report
Archive Number: 20120805.1228593

INFLUENZA (64); UNITED STATES OF AMERICA A/(H3N2)V CENTERS FOR DISEASE CONTROL AND PREVENTION REPORT
************************************************** ************************************************** *
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


Date: Fri 3 Aug 2012

Source: Seasonal Influenza (Flu) ,CDC

http://www.cdc.gov/flu/spotlights/h3n2v_us_cases.htm





CDC Reports Cases 18-29 of H3N2v Virus Infection; Continues to Recommend Interim Precautions When Interacting with Pigs


-------


This week CDC [US Centers for Disease Control and Prevention] reports 12 additional human infections with influenza A (H3N2) variant virus in 3 states: Hawaii (1 case), Ohio (10 cases) and Indiana (1 case). The H3N2v virus contains the M gene from the human influenza A(H1N1)pdm09 (2009 H1N1) virus, as have the previous 17 cases detected since July 2011 [last year]. All of this week's reported cases occurred in people who had direct or indirect contact with swine prior to their illness. The 10 cases in Ohio were associated with attendance at a fair where reportedly ill swine were present. The H3N2v case reported by Indiana also occurred in a person who attended a fair where swine were present. CDC continues to recommend preventive actions people can take to make their fair experience a safe and healthy one.



The number of cases of infection with H3N2v viruses with the M gene from the 2009 H1N1 virus detected in the United States since July 2011 now totals 29 [Hawaii (1), Indiana (7), Iowa (3), Ohio (10), Maine (2), Pennsylvania (3), Utah (1), and West Virginia (2)]. Twenty-three of these cases reported swine contact prior to illness onset. Among those 29 cases, 19 cases were associated with fairs where swine were present. Most human illness with H3N2v virus infection has resulted in signs and symptoms of influenza (fever, cough, runny nose, sore throat, muscle aches); 3 hospitalizations have occurred. All of the people hospitalized had high risk conditions. All H3N2v virus cases have recovered fully.



According to USDA [US Department of Agriculture] swine influenza surveillance, this swine H3N2 virus with the pandemic [virus] M gene has been detected in swine in a number of U.S. states. This virus may be circulating widely in U.S. swine at this time. It should be noted, however, that influenza viruses have not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. It is possible that acquisition of the M gene from the 2009 H1N1 virus may allow H3N2v viruses to be more transmissible from pigs to people and from person-to-person.



Late summer is typically fair season across the United States, and fairs are a setting that can provide many opportunities for exposures to occur between pigs and people. CDC continues to advise people to take recommended precautions when interacting with pigs or their environments, including frequent hand washing and avoiding contact with pigs that appear ill. The National Association of State Public Health Veterinarians has developed the "Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2011" to provide some preventive actions that are applicable to people raising swine, showing swine at fairs, or attending fairs.



This includes:

- Wash your hands frequently with soap and running water before and after exposure to animals.

- Never eat, drink or put things in your mouth while in animal areas and don't take food or drink into animal areas.

- Young children, pregnant women, people 65 and older and people with weakened immune systems should be extra careful around animals.

- If you have animals -- including swine -- watch them for signs of illness and call a veterinarian if you suspect they might be sick.

- Avoid close contact with animals that look or act ill, when possible.

- Avoid contact with pigs if you are experiencing flu-like symptoms.

- If you must come in contact with pigs while you are sick, or if you must come in contact with pigs known or suspected to be infected, or their environment, you should use appropriate protective measures (for example, wear protective clothing, gloves, masks that cover your mouth and nose, and other personal protective equipment) and practice good respiratory and hand hygiene.



Additionally, in response to recent human cases of H3N2v virus infection, CDC would like to convey the following information:



1. Children younger than 5 years, people 65 years and older, pregnant women, and people with certain chronic medical conditions (like asthma, diabetes, heart disease, weakened immune systems, and neurological or neurodevelopmental conditions) are at high risk from serious complications if they get influenza. These people should consider avoiding exposure to pigs and swine barns this summer, especially if sick pigs have been identified.



2. Studies conducted by CDC have indicated that children younger than 10 years old would have little to no immunity against H3N2v virus, whereas adults may have some cross-protective immunity. Most cases of H3N2v have occurred in children at this time.



3. There are two FDA-approved drugs that are expected to be effective in treating illness associated with H3N2v virus infection. The antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) - which are used to treat infection with human seasonal influenza viruses -- are also expected to be effective in treating H3N2v virus. Antiviral treatment is most effective when started as soon as possible after illness onset.



4. Signs and symptoms of H3N2v virus infection cannot be differentiated from those caused by other respiratory infections, including seasonal influenza virus infection.



5. Rapid influenza diagnostic tests may not detect H3N2v virus in human respiratory specimens ([they may give] false negative results). If H3N2v virus infection is suspected because of recent exposure to pigs or to an ill person who had contact with pigs, testing of respiratory specimens should be done at a state health department.



6. Influenza viruses have not been shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs.



--

Communicated by:

ProMED-mail Rapporteur Kunihiko Iizuka

[While swine influenza A viruses seldom infect humans, such infections have occurred. Human infections with swine viruses are thought to occur in the same way that seasonal influenza viruses spread among people. Pigs that are infected shed influenza virus -- possibly in coughs or sneezes -- and people who are nearby can breathe the virus in. Infection also may occur by a person touching a surface or object that has virus on it and then touching their own mouth or nose."



Signs of swine flu in pigs can include fever, depression, coughing (barking), discharge from the nose or eyes, sneezing, breathing difficulties, eye redness or inflammation, and going off feed. Some pigs infected with influenza viruses, however, may have no symptoms at all.



More information about H3N2v is available on the CDC website at "Information on H3N2 Variant Influenza A Viruses"

http://www.cdc.gov/flu/swineflu/infl...uses-h3n2v.htm.



Influenza A/(H3N2)v viruses have only been detected in North America so far. - Mod.CP]



[In order to improve communications and avoid confusion, FAO, OIE and WHO established, in late 2011, a working group of experts to standardize the terminology for variant influenza viruses. The joint recommendation for the above mentioned A(H3N2) virus was: A (H3N2)v , where "v" stands for "variant". Subclinical or mild cases of influenza have been reportedly observed in swine in contact with infected humans (eg a county fair in Indiana) where the A (H3N2)v strain was identified in both man and animal. These cases are not regarded as the OIE-notifiable "Swine influenza", a highly contagious viral infection of pigs caused by pathogenic Swine Influenza Virus (SIV) strains. In some instances, SIV infections are associated with reproductive disorders such as abortion. Morbidity rates can reach 100% with SIV infections, while mortality rates are generally low. Secondary bacterial infections can exacerbate the clinical signs following infection with SIV. Transmission is through contact with SIV-containing secretions such as nasal discharges and aerosols created by coughing or sneezing.(H3N2)v causing sub-clinical or mild disease in swine, seems not to be regarded as the notifiable SIV. During 2009/2010, when the A(H1N1)pdm09 virus (Pandemic influenza A/H1N1 (2009) virus) was reportedly spreading globally in humans, becoming a cause for international concern, more than 20 countries notified the OIE about the identification of the virus in swine, as an "emerging disease". This virus was generally regarded to spread through the human-to-swine route. - Mod.ARN]



[The Hawaiian case presents a puzzle. In ProMED post Influenza (61): USA (HI) A/(H3N2)v, pig worker, 20120802.1225864, state veterinarian Dr. James Foppoli is quoted as saying "Human-to-human transmission is uncommon, so that's not a likely source. You've got to suspect that there's a pig intermediate somewhere along the line where the person got the virus." Since there is no suggestion that the human had become infected during travel outside Hawaii, is that island importing pigs from the USA mainland? - Mod.JW]




See Also

http://www.promedmail.org/direct.php...120803.1227741

[Kassy]

Published Date: 2012-08-06 10:10:45
Subject: PRO/AH> Influenza (65): swine influenza, A/(H3N2)v, OIE status
Archive Number: 20120806.1229963

INFLUENZA (65): SWINE INFLUENZA, A/(H3N2)V, OIE STATUS
************************************************** ****
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Mon 6 Aug 2012
From: Arnon Shimshony, ProMED-mail Animal Disease and Zoonoses Moderator <promed@promedmail.org>


Swine influenza - OIE status
----------------------------
The undersigned's commentary to ProMED-mail's posting "Influenza (64): USA A/(H3N2)v CDC report," archive number 20120805.1228593, suggested that the subclinical or mild cases of influenza virus A/(H3N2)v recently recorded in swine in the USA are "not regarded as OIE-notifiable swine influenza."

This is in need of correction and clarification.

Swine influenza is not a listed disease with the OIE. The current list includes the following 7 swine diseases: African swine fever, classical swine fever, Nipah virus encephalitis, porcine cysticercosis, porcine reproductive and respiratory syndrome, swine vesicular disease and transmissible gastroenteritis.

As laid out in OIE's Disease Information Summary on Swine Influenza (http://tinyurl.com/brs96wx), the reason for the disease not being listed is explained by its low mortality rate and its being a "very uncommonly documented human disease." Accordingly, it does not meet OIE criteria for disease notification. The criteria that are democratically adopted by all OIE Members can be found in chapter 1.2 of the OIE Terrestrial Animal Health Code; see http://www.oie.int/index.php?id=169&...itre_1.1.2.htm.

OIE's definition of "Emerging disease" is: "A new infection resulting from the evolution or change of an existing pathogenic agent, a known infection spreading to a new geographic area or population, or a previously unrecognized pathogenic agent or disease diagnosed for the 1st time and which has a significant impact on animal or public health."

A non-listed animal disease is officially required to be immediately notified if determined as "an emerging disease with significant morbidity or mortality, or zoonotic potential." This is spelled out in Article 1.1.3.1.e of the Terrestrial Animal Health Code.

In 2009/2010, countries from 3 continents notified to the OIE diagnosed cases in swine and other animal species of "Pandemic A/H1N1 virus (2009)," caused by the novel A(H1N1)pdm09 virus, as an "emerging disease." The OIE encourages members to carry out surveillance and reporting of the presence of all epidemiologic events of significance in animals due to influenza viruses.

A joint OIE-FAO network of expertise on influenza, called OFFLU, was established in 2005. It initially engaged in international efforts to monitor and control infections of avian influenza in poultry and other bird species and to share biological material and data to support early development of human pandemic vaccines, and later expanded its role to cover all animal influenza viruses, including swine influenza.

A chapter on swine influenza is included in OIE's Manual of Diagnostic Tests and Vaccines for Terrestrial Animals. A new version of the said chapter 2.8.8. was adopted by OIE's General Session, Paris, May 2010 (available on-line at http://www.oie.int/fileadmin/Home/en..._INFLUENZA.pdf).

--
Arnon Shimshony
ProMED-mail Animal Disease and Zoonoses Moderator
<promed@promedmail.org>


See Also
http://www.promedmail.org/direct.php...120806.1229963

[D. Gale]

Just heard this on the Indianapolis news:

Indiana State Fair officials dismiss swine over influenza concerns

State Fair officials dismissed all animals from the Swine Barn following concerns over swine flu Monday.

The Board of Animal Health recommended dismissing the animals one day earlier than scheduled after six pigs in the 4-H show developed temperatures above 105 degrees.

All pigs who arrived at the State Fair had their temperatures taken before they were allowed out of their trailers. The tests came after four confirmed cases of swine flu in people were reported at the La Porte County Fair. Unconfirmed cases were also possible in Hendricks, Jackson and Monroe Counties.

Samples from the hogs sent home have been submitted to the Purdue Animal Disease Diagnostic Laboratory. Results won't be available for several days.

More at link: http://www.fox59.com/news/statefair2...5604521.column

[Kassy]

Good start but the problem with swine flu is that it's not usually noticable in the animals. We don't ever lose much production over swine flu (no noticable increase in mortality even in the young pigs) which is why there's scarce surveillance.

[Catbird]

Big jump in the numbers.

"Indiana says swine flu cases rise ten-fold, now at 113"

"Swine flu is spreading in Indiana, with human cases rising tenfold in a week, state public health officials said on Wednesday, confirming 113 people are infected and saying they expect to see more.

The total confirmed cases of the Influenza A variant virus that has been transmissible from swine to humans in Indiana jumped from just 11 last week. The cases, which show symptoms of a mild seasonal flu, have been found in 18 counties across the state, state health official said."

[D. Gale]

Originally Posted by Catbird

Big jump in the numbers.

"Indiana says swine flu cases rise ten-fold, now at 113"

Greeeeaaaaaaaat. School started this week, too. Watch the numbers jump even higher.

[Kassy]

I'd like to know how many and which of the cases are related to eachother.
Put simpler how many clusters/related clusters of cases are there among them.

Checked some articles but all as general as the linked one.

[Catbird]

There might be some specific info in the next weekly CDC flu update. Maybe.

According to a CIDRAP article, the Ohio Dept. of Health says:

""There are currently 30 cases of H3N2v statewide; all individuals had direct contact with swine at fairs and no human-to-human passage of the virus has been confirmed." The counties and their case numbers are Butler, 16; Clark, 3; Gallia, 4; Greene, 4; and Hamilton, 3.

The Ohio patients range from 6 months to 36 years old, the statement said. It said one patient was hospitalized as a precaution but has since been released. "

The Indiana Dept. of Health released a statement yesterday. Like Ohio, it doesn't provide much specific info.

"Health officials have now confirmed 113 cases of variant influenza A (H3N2v), impacting 18 counties statewide. State and local health officials continue to investigate the outbreak. More cases are expected to be confirmed this week.

Variant influenza A cases have been confirmed in the following counties: Bartholomew, Greene, Hamilton, Hendricks, Jackson, Jennings, Johnson, Kosciusko, LaPorte, Lawrence, Monroe, Morgan, Owen, Porter, Scott, Tipton, Washington, and White.

...Health officials have not determined person to person transmission at this time, but continue to investigate the possibility."

The CIDRAP article does identify one fairly large cluster:

"A report from Indiana Public Media today said 68 people in Monroe County have contracted the virus. Penny Caudill, administrator of the Monroe County health Department, said the virus does not appear to have spread from person to person, according to the story. The swine barn at the Monroe County Fair was closed last week because of sickness among the pigs. "

An article in the Indianapolis Star mentions an age range:

"...most of the ill in Indiana have been younger than 25, Larkin said. All of the Ohio cases occurred in people between the ages of six months and 36 years."

In that same article, published this morning, the State Health Commissioner says that there were about 40 cases in Monroe County. So there seems to be some question about that number. I also wonder how a 6 month old baby came in direct contact with pigs. Theoretically I guess a pig could have sneezed near the baby, but it still seems unlikely.

[CanadaSue]

Variant H3N2 cases surge in Indiana, Ohio
-----------------------------------------
The count of swine-origin variant H3N2 influenza (H3N2v) cases in Indiana soared to 113 today [8 Aug 2012], a jump of about 100, while Ohio reported a total of 30 cases, double the previous number. But the states said they have not found any person-to-person transmission of the virus.

In a news release, the Indiana State Department of Health (ISDH) said the 113 cases are scattered among 18 counties and predicted that more cases would be confirmed this week. Most of the previous cases have been in children who had contact with pigs at county fairs, but today's announcement gave no details about the patients' age range, swine exposure, or severity of illness. The Ohio announcement states, "There are currently 30 cases of H3N2v statewide; all individuals had direct contact with swine at fairs and no human-to-human passage of the virus has been confirmed." The counties and their case numbers are Butler, 16; Clark, 3; Gallia, 4; Greene, 4; and Hamilton, 3.

The Ohio patients range from 6 months to 36 years old, the statement said. It said one patient was hospitalized as a precaution but has since been released. One other H3N2v case was reported recently in Hawaii. With the new Indiana and Ohio cases, the apparent total for the past few weeks has now reached 144. However, Tom Skinner, a spokesman for the US Centers for Disease Control and Prevention (CDC), cautioned that the growing case count in part reflects increased testing and that some of the cases may not ultimately be confirmed.

"The increase in Indiana and soon to be other states is because states are now reporting presumptive positive cases based on testing in their labs and part of this is because of increasing numbers of samples arrived for testing compared with last week," Skinner commented via e-mail. He added that the CDC believes most of the cases are still due to contact with pigs. "However, limited human-to-human transmission with this virus has been observed in the past, and we expect that some human to human spread will be observed in these current outbreaks," he said. The Indiana release said, "Health officials have not determined person-to-person transmission at this time, but continue to investigate the possibility."

Skinner and officials from the 2 states reemphasized the need to take precautions around pigs and when attending fairs. People should wash their hands before and after touching animals and should avoid eating, drinking, or putting anything in the mouth when visiting animal areas, officials said. They also reiterated that the virus is not spread through eating properly prepared pork. The CDC has said that people who have an increased risk for flu complications, such as the elderly, small children, and those with chronic diseases, should consider avoiding pigs and swine barns this summer. "It's important for folks to remember this is a mild illness with symptoms similar to what we see with seasonal flu," said State Health Commissioner Gregory Larkin, MD, in the Indiana statement today. The CDC has developed a candidate vaccine for the new strain, and clinical trials of versions made by two companies are expected this fall.

Indiana counties that have had H3N2v cases, according to today's announcement, are Bartholomew, Greene, Hamilton, Hendricks, Jackson, Jennings, Johnson, Kosciusko, LaPorte, Lawrence, Monroe, Morgan, Owen, Porter, Scott, Tipton, Washington, and White. A report from Indiana Public Media today said 68 people in Monroe County have contracted the virus. Penny Caudill, administrator of the Monroe County health Department, said the virus does not appear to have spread from person to person, according to the story. The swine barn at the Monroe County Fair was closed last week because of sickness among the pigs.

[Byline: Robert Roos, Lisa Schnirring]

*****
CDC: 158 cases of new swine flu strain from pigs
------------------------------------
Health officials Thursday reported a five-fold increase of cases of a new strain of swine flu that spreads from pigs to people.

The cumulative case count jumped from 29 a week ago to 158 this week, thanks to a wave of new cases confirmed in Indiana and Ohio, the Centers for Disease Control and Prevention said. Most of the cases have been tied to state and county agricultural fairs, where visitors are put in close contact with infected pigs, said the CDC's Dr. Joseph Bresee.

The recent cases include at least 113 in Indiana, 30 in Ohio, one in Hawaii and one in Illinois, Bresee said.

Most of the infected patients are children -- probably because many were working closely with raising, displaying and visiting pigs at the agricultural fairs, Bresee said.

Also, diagnosis of cases has become quicker in the last week. CDC no longer must confirm a case with its own lab. Now states are using CDC test kits to confirm cases on their own on, speeding the process along. The patients were likely infected a week or two ago.

The CDC has been tracking cases since last summer. A concern: the new strain has a gene from the 2009 pandemic strain that might let it spread more easily than pig viruses normally do.

The good news is the flu does not seem to be unusually dangerous. Almost all of the illnesses have been mild and no one has died. Two of the recent cases were hospitalized, but both recovered and were discharged, added Bresee, the agency's chief of influenza epidemiology.

More good news is that all of the recent cases appear to have spread from pigs to humans, meaning it's not very contagious, at least between people.

But there probably will be more cases in the weeks ahead, and it won't be surprising if at least a few of them involve person-to-person transmission, Bresee said.end of story marker

[byline: Mike Stobbe]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Type A influenza viruses, including H3N2 and its variants, commonly infect swine, causing outbreaks among swine herds. Most of the type A influenza viruses that infect swine are genetically very different from human (seasonal) influenza viruses. While these variant swine influenza viruses seldom infect humans, such infections can and do occur. In fact, influenza viruses can spread both from swine to humans and from humans to swine. The A(H3N2)v swine influenza virus strain currently causing human infections at agricultural fairs in some parts of the United States has not so far been detected in pigs in European countries.

Only people in direct contact with infected swine, such as in swine barns and livestock exhibits housing swine at fairs, are likely to be at risk of contracting this H3N2v strain of influenza virus. However transmission of this strain of H3N2v influenza virus is thought to occur in the same way that seasonal flu transmits in people, which is mainly through coughing or sneezing by people who are infected. People also may become infected by touching something with flu viruses on it and then touching their mouth or nose. It's important to note that in most cases, variant flu viruses have not shown the ability to spread easily and sustainably from person to person.

Maps:
Indiana: http://healthmap.org/r/1DmR and http://www.digital-topo-maps.com/cou.../indiana.shtml (counties)
Ohio: http://healthmap.org/r/1BY2 and
http://www.digital-topo-maps.com/county-map/ohio.shtml (counties). - Mod.CP]

[We have learned that the vast majority of human H3N2v infection has been in children. This may reflect immunologic susceptibility due to lack of prior exposure to similar viruses or vaccine antigens, greater exposure of children to swine at agricultural fairs, or a combination of factors. Case numbers will undoubtedly rise as awareness increases and more people are tested. - Mod.LM]

[Auburn Boy]

CDC Reporting over 150 cases of the new flu so far..,

Darned AP..,

http://www.mercurynews.com/breaking-...lu-strain-from

My biggest worry is the mixing ability of Flu virii.

[Exodia]

Illness so far seems "mild" although the number of people becoming infected has taking a jump this year (compared to when it emerged), so that my be a signal of more adaptation to humans. Certainly something to keep an eye on (especially since DD will be showing her hog at our fair next week).

[Catbird]

The CDC held a teleconference media briefing on this yesterday. You can find the transcript here.

Some of the significant info from the briefing:

- The CDC has authorized testing at the state level, so new case counts will be announced by the individual states. The CDC will only post case info on a weekly basis, either in the MMWR or the weekly Influenza Surveillance Report.

- The CDC declined to release specifics on any cases, except to say that there have been 2 hospitalizations since July, with both of those now discharged. Over 90% of the cases are in children.

- There's not been any evidence of human to human transmission yet, although the CDC "expects" to see that happening. They are also testing some suspected cases from other states (not specified).


So, based on this briefing, it seems unlikely that specific info about cases clusters will be released. And we'll have to watch for announcements from the different state health departments in order to get current numbers and any further, or more specific, info.

[Catbird]

Every time we encounter something like this, it seems that there ends up being massive confusion about the numbers as reported by the media. So I thought it would be useful to post this chart from the CDC's page on H3N2v as a starting point.


Case Count: Detected U.S. Human Infections with H3N2v by State since August 2011 (as of Aug. 9)

States Reporting H3N2v Cases

Hawaii - 2011: 1
Indiana - 2011: 2 2012: 113
Illinois - 2012: 1
Iowa - 2011: 3
Maine - 2011: 2
Ohio - 2012: 30
Pennsylvania - 2011: 3
Utah - 2012: 1*
West Virginia - 2011: 2

Total - 2011: 12 2012: 146

* Case in Utah occurred in April 2012 and is not part of the ongoing outbreaks.



As of today, Indiana is reporting 120 cases, raising the total to 153.

If anyone has different numbers, please post them so that maybe we can clear up the confusion before the numbers get too large to get a handle on.


ETA: I know that there's a way to post this as a chart but I don't know how. Could someone please give me a clue?

ETA 2: Until I can figure out the table thing, I've edited the format so that the numbers reflect the correct year.

[Sysiphus]

I hope they get the vaccine going soon. Just in case. This seems to be a very stubborn and persistent strain.

[Exodia]

Link to previous thread if anyone is interested in looking back at last year's developements.

http://thisbluemarble.com/showthread.php?t=39843