ISDH: Indiana Announces 6 More H3N2v Cases

 

# 6473

 

 

As expected, more H3N2v cases have been confirmed as the epidemiological investigations into the flu outbreaks related to swine exposure in the Midwest continues.

 

At yesterday’s noon briefing by the CDC (see CDC Teleconference & HAN Advisory On H3N2v), 16 new cases had been confirmed over the past three weeks.

 

Late yesterday, Indiana’s ISDH announced the confirmation of 6 more cases, raising the total for that state to 11.

 

While It is likely that there are other (as yet, unidentified) cases in the region, the CDC has not seen any signs of sustained and efficient human-to-human transmission of this virus.

 

For now, most of the cases appear to be due to direct exposure to pigs.

 

This update from Indiana’s State Department of Health.

 

Health Officials Confirm 11 Cases of Flu Illness Statewide

8/3/2012

INDIANAPOLIS— Health officials have confirmed six additional cases of variant influenza A, bringing the total case number to 11 statewide. All cases have been linked to swine. The Indiana State Department of Health and local health departments continue to investigate potential new cases.

 

The additional cases were identified in Tipton, Jennings and LaPorte counties. Jackson County has also experienced four cases.

 

“We haven’t seen any transmission from person to person at this point,” said State Health Commissioner Gregory Larkin, M.D. “All of the confirmed cases have had direct contact with swine. As Hoosiers visit fairs around the state this summer, they should take extra care to practice thorough hand washing and avoid eating when around animals.”

 

Flu symptoms usually include fever and respiratory symptoms, such as cough, sore throat, and runny nose, and possibly other symptoms, such as body aches, nausea or vomiting, or diarrhea.  Symptoms usually last about two to five days.

 

Variant Influenza A virus can be directly transmitted from swine to people and from people to swine. Human infections are most likely to occur when people are in close proximity to live infected pigs, such as working with them in barns and livestock exhibits at fairs.  Influenza viruses are not transmitted by eating pork and pork products.

 

While influenza is not an uncommon diagnosis in pigs, the State Board of Animal Health encourages swine owners to contact a veterinarian if their animals show signs consistent with flu, including coughing, respiratory illness, off-feed and fever. Most county fairs have a private veterinary practitioner on call for on-site assistance.

 

Hoosiers are encouraged to wash hands with soap and water before and after petting or touching any animal.  Never eat, drink, or put anything in your mouth when visiting animal areas.  Older adults, pregnant women, young children, and people with weakened immune systems should be extra careful around animals.

 

The best way to prevent spread of influenza is to practice good hygiene.  Wash your hands frequently. Cough or sneeze into your sleeve or elbow.  If possible, avoid contact with those who are ill.  Stay home if you develop influenza symptoms and contact your health care provider.

 

Additional information regarding influenza can be found at the Indiana State Department of Health website at www.in.gov/isdh/25462.htm.

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While many in the mainstream press are apparently just discovering this `new swine H3N2v virus’, this flu strain  has been on the infectious disease radar screen for at least a year.

 

For a review of the dozen or so human cases leading up to the recent outbreaks in Ohio and Indiana (and one case in Hawaii), you may wish to revisit my blog from earlier this week called A Variant Flu Review.

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Indiana: Swine Flu Information Call Center To Open

 

 

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This morning the ISDH (Indiana State Department of Health) announced that a telephone call center will open this afternoon to field questions about the small number swine H3N2v influenza infections reported around the state (see ISDH: Fifth H3N2v Case In Indiana).

 

Here is the official press release:

 

State Health Department to Open Call Center for Influenza Questions

INDIANAPOLIS—A call center will open this afternoon from 1-4 p.m. to answer questions regarding influenza infection, the Indiana State Department of Health announced today. Beginning next week, the call center will be open from 8:15 a.m.-4:45 p.m., Monday through Friday.  The call center telephone number is (877) 826-0011.

 

Five confirmed cases of variant influenza A have been identified in Indiana since mid-July.  Laboratory testing is pending on potential additional cases. To date, all cases have had contact with swine.  The State Health Department continues to monitor influenza activity statewide.

 

To avoid influenza and other respiratory infections, Hoosiers are reminded to follow these simple practices:

• Wash your hands frequently, including before and after touching animals.
• Never eat, drink, or put anything in your mouth when visiting animal areas. 
• Older adults, pregnant women, young children, and people with weakened immune systems should be extra careful around animals. 
• Cough or sneeze into your sleeve or elbow. 
• If possible, avoid contact with those who are ill. 
• Stay home if you develop influenza symptoms and contact your health care provider. 

Additional information regarding influenza can be found at the Indiana State Department of Health website at www.in.gov/isdh/25462.htm.

 

 

Neighboring Ohio confirmed 9 cases of H3N2v influenza yesterday, and more tests are pending (see CDC Confirms H3N2v In Butler County Outbreak).

 

Overnight media reports indicated that 2 hogs from the Ohio State fair had tested positive for swine influenza, and had been sent home (see 2 pigs at state fair have swine flu – Columbus Dispatch).

 

The State Fair in Columbus, Ohio closes this weekend ending a two week run (July 25th- Aug. 5th).

 

Epidemiological investigations continue in both states looking to determine how many cases of human (and swine) infections with the H3N2v virus have occurred, and the manner in which it is being transmitted.

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ISDH: Fifth H3N2v Case In Indiana

Credit Wikipedia

# 6467

 

Today the ISDH (Indiana State Health Department) announced that a fifth case of H3N2v infection has been confirmed  - this time in Jackson County.  While few details are offered in this update, this case is once again apparently linked to exposure to swine.

 

As the epidemiological investigation expands, it is likely we will learn of additional cases.  

 

Health Officials Continue to Investigate Flu Illness

Start Date: 8/2/2012

INDIANAPOLIS—The Indiana State Department of Health has identified a case of variant influenza A in Jackson County, bringing the total to five cases statewide.  All cases have been linked to swine.  Laboratory testing is pending on potential additional cases.

The State Health Department has detected increased influenza activity in different areas of the state.  Flu symptoms usually include fever and respiratory symptoms, such as cough, sore throat, and runny nose, and possibly other symptoms, such as body aches, nausea or vomiting, or diarrhea.  Symptoms usually last about 2 to 5 days.

Variant Influenza A virus can be directly transmitted from swine to people and from people to swine. Human infections are most likely to occur when people are in close proximity to live infected pigs, such as working with them in barns and livestock exhibits at fairs.  Influenza viruses are not transmitted by eating pork and pork products.

While influenza is not an uncommon diagnosis in pigs, the State Board of Animal Health encourages swine owners to contact a veterinarian if their animals show signs consistent with flu, including coughing, respiratory illness, off-feed and fever. Most county fairs have a private veterinary practitioner on call for on-site assistance.

Hoosiers are encouraged to wash hands with soap and water before and after petting or touching any animal.  Never eat, drink, or put anything in your mouth when visiting animal areas.  Older adults, pregnant women, young children, and people with weakened immune systems should be extra careful around animals.

The best way to prevent spread of influenza is to practice good hygiene.  Wash your hands frequently. Cough or sneeze into your sleeve or elbow.  If possible, avoid contact with those who are ill.  Stay home if you develop influenza symptoms and contact your health care provider.

Additional information regarding influenza can be found at the Indiana State Department of Health website at wwwS.in.gov/isdh/25462.htm.

 

 

Reports of recent cases of H3N2v over the past week can be viewed at:

Ohio Investigating Possible H3N2v Outbreak

Hawaii’s DOH on H3N2v Flu Detected On Maui

Swine Flu Precautions Close Pig Barn At Indiana County Fair

H3N2v: CDC Offers Advice To Fair Goers

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MMWR On The H3N2v Outbreak In LaPorte, Indiana

  

Photo Credit CDC

 

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Today’s MMWR from the CDC carries a brief report on the outbreak, in humans and swine, of the H3N2v flu virus that I blogged on twice yesterday (see Reports Of H3N2v In Indiana and ISDH Statement On H3N2v).

 

Among other things, this report confirms that this virus is indeed similar to the H3N3v viruses we’ve seen since August of 2011; a reassortment of the swine H3N2 virus with the Matrix (M) gene segment from the 2009 H1N1 virus.

 

All four confirmed cases have recovered, and none required hospitalization. This is obviously a very early report from the field, and I expect we’ll see more detailed information in the future.

 

 

Notes from the Field: Outbreak of Influenza A (H3N2) Virus Among Persons and Swine at a County Fair — Indiana, July 2012

Weekly

July 27, 2012 / 61(29);561-561

During July 12–16, 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 July 8–14. On July 16, specimens were collected from four persons with respiratory illness; two had become ill on July 12 and sought care at an emergency department, and two were identified as part of the subsequent public health investigation. All four persons were swine exhibitors or family members of swine exhibitors and had close contact with swine. On July 18, reverse transcription–polymerase chain reaction testing at the Indiana State Department of Health laboratory identified suspected influenza A (H3N2) variant (H3N2v) virus* in all four specimens. On July 21, partial genome sequencing at CDC confirmed H3N2v virus with the influenza A (H1N1)pdm09 virus M gene; the viruses detected in the four specimens are similar to 12 viruses detected in 2011 and one detected earlier this year (1). None of the four persons were hospitalized, and all have fully recovered.

 

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/influenza-variant-viruses-h3n2v.htm.

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Reports Of H3N2v In Indiana

 

 

SEE UPDATE AT ISDH Statement On H3N2v

# 6449

 

Over the past year we’ve been carefully watching the evolution and spread of a novel swine flu variant called H3N2v (formerly trH3N2), which is a reassortment of the swine H3N2 virus with the Matrix (M) gene segment from the 2009 H1N1 virus.

 

So far, the number of cases has been small, and while some human-to-human transmission appears to have occurred, the CDC has not seen evidence of sustained and efficient transmission in humans.

 

The last reported human detection goes back to March of this year (see CDC Update On Utah H3N2v Infection), but overnight local media outlets and the Associated Press are reporting on a small cluster of H3N2v that occurred recently, apparently in connection with infected swine at the LaPorte County Fair (held July 8th-14th).

 

First, a quick look at a couple of these reports, then I’ll return with more on variant influenza. From the AP:

 

4 LaPorte C. flu-like illnesses linked to swine

Jul 24, 2012 5:45pm

INDIANAPOLIS (AP) — Health officials say four people who've developed flu-like illnesses all had direct contact with swine at the LaPorte County Fair in northwestern Indiana.

(Continue . . .)

 

This short report goes on to say that the ISDH has confirmed a `variant influenza A virus’ in these four people, and that the same virus has been isolated in local swine.

 

While H3N2v is not directly identified in the AP report, it does appear prominently in other reports, including this lengthy one from the local CBS network affiliate WSBT (includes a 3 minute video newscast).

 

Health officials: Kids, pigs at LaPorte County Fair ill from same virus

(excerpt)

The Indiana State Department of Health, Centers for Disease Control and the USDA National Veterinary Services laboratory in Iowa found 4 people and all 12 randomly selected pigs from the LaPorte County Fair swine barn had what’s called influenza A (H3N2)v – a strain of influenza in the same family as swine flu.

(Continue . . .)

 

 

While only 4 new human cases have tested positive for the virus, WSBT reports talking to the parents of a number of children who also fell ill with flu-like symptoms after visiting the pig barn.

 

According to this report, some local citizens have expressed deep concerns over the handling of this outbreak at the fair, stating that organizers did not quarantine the pigs even after 41 were found to have high fevers.

 

In the past, we have seen reluctance on the part of some hog farmers to test their herds after the bad publicity their industry suffered during the 2009 H1N1 (`Swine Flu’) pandemic (see Swine Flu: Don’t Test, Don’t Tell).

 

As to the exact strain in this outbreak, the reports are calling it H3N2v and suggest that it is the same strain that has previously been detected in 13 people over the past 12 months. 

 

We’ll obviously be interested in a more precise description from the CDC in the coming days.

 

Swine are highly susceptible to the influenza virus, and are capable of serving as `mixing vessels’, allowing them to reassort into new hybrid strains. When that happens, once in a great while a swine virus can emerge that is capable of spreading in humans.

 

 

While the number of confirmed H3N2v infections remain small, the CDC is obviously concerned and has ordered enhanced surveillance, testing, and reporting around the country as to better gauge the prevalence of this virus.

 

In January we learned that the CDC was working on a vaccine candidate (see H3N2v Vaccine Trials), in the event this virus ever develops `legs’. And earlier this year the CDC Released Updated H3N2v Interim Guidance  documents.

 

For the most part, these documents provide background information, context, and a bit of advice for specific groups on the emergence of this new variant virus.

 

Seventeen cases over a year’s time (even assuming a substantial number of undetected cases) does not a pandemic make - and so far at least - we are not aware of this virus causing any serious illness or death.

 

This virus has, thus far, mostly affected children.

 

In April of 2012 we saw a study (see MMWR: Antibodies Cross-Reactive to Influenza A (H3N2) Variant Virus) that found that children under the age of 10 had few or no cross-reactive antibodies to the H3N2v strain, suggesting they would be the most vulnerable age group to the virus.

 

However, another study I blogged about in Eurosurveillance: Older People May Be Susceptible To The H3N2v Virus suggests that acquired immunity to this virus may wane over time.

 

 

Although this swine flu variant could one day evolve into a greater public health concern, it could also up in the evolutionary dustbin of failed organisms; little more than an interesting footnote in the history of influenza in the 21st century.

 

For now, the threat to the public appears low, and we remain in a watchful waiting mode. But anytime a virus jumps species – as this one has - we are particularly attentive.

 

For more on the H3N2v virus, you may wish to revisit some of these older blogs.

Eurosurveillance: Cross Reactive Antibodies to H3N2v In Norway

H3N2v: Three’s A Crowd

MMWR: H3N2v Transmission and Guidelines

WHO/FAO/OIE: Call It A(H3N2)v

 

And for more background on variant flu viruses, you may wish to visit the following CDC webpage:

 

Key Facts about Human Infections with Variant Viruses (Swine Origin Influenza Viruses in Humans)

Questions & Answers

On this Page

• What is swine influenza?
• What is a variant influenza virus?
• Can humans be infected with swine influenza viruses?
• How common is it for humans to be infected with influenza viruses that normally spread in swine?
• Why are human infections with variant viruses of concern?
• What symptoms do people have when they are infected with variant viruses?

• Can people catch swine flu/variant flu from eating pork?
• How are variant influenza viruses spread?
• How can human infections with variant influenza viruses be diagnosed?
• What medications are available to treat variant flu infections in humans?
• What other examples of outbreaks with influenza viruses that normally circulate in swine are there?
• Was the “2009 H1N1” pandemic virus the same as previously circulating human H1N1 viruses?

 

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