Saturday, August 04, 2018

Michigan DOH: 2 People Test Positive For Influenza After Contact With Infected Swine



Six days ago, in Michigan: Pigs At Fowlerville Family Fair Test Positive For Swine Flu, we saw a report from the Michigan Department of Agriculture and Rural Development (MDARD) announcing that pigs at the Fowlerville Family Fair had tested positive for swine flu (influenza A).
For reasons that elude me, the strain of swine flu has not been publicly identified in any of the media reports I've seen.
Typically North American swine flu viruses are H3N2, H1N1, or H1N2 - although other variants have occasionally been reported (see 2015's J. Virol: Novel Reassortant Human-like H3N2 & H3N1 Influenza A Viruses In Pigs.)
When they jump from pigs to humans, they are dubbed swine variant viruses and acquire a `v' suffix after the subtype.
Since 2011 - after North American swine flu viruses picked up the M gene from the 2009 pandemic H1N1 virus - we've seen an increased number of human infections, often linked to exposure to pigs at county and state fairs.
Last year, 67 human infections were reported.
For the past couple of days there have been rumors of some `symptomatic' attendees from last month's Fowlerville fair, but the CDC's weekly FluView (released yesterday) carried no mention of human cases.

Local fair officials quoted two days ago in the media attempted to `play down' the possibility of there being any human infections. One official, in response to reports that some fairgoers had reported symptoms, went so far as to suggest `Some people have talked themselves into it.'
County and State fairs are big business - particularly in Midwestern States - and the risks from these emerging swine variant viruses apparently aren't fully appreciated.
Late Friday afternoon the Michigan Department of Health & Human Services released the following statement, indicating that at least two fair attendees have tested positive for Influenza A (again, subtype not given), and `Additional fair attendees are also reporting influenza-like illness and are being tested'.

After the MDHHS statement, I'll return with more.

Influenza A identified in Michigan residents with exposure to swine  
For IMEDIATE RELEASE: Aug. 3, 2018

CONTACT: Lynn Sutfin, 517-241-2112

LANSING, Mich. – The Michigan Department of Health and Human Services (MDHHS) and the Livingston County Health Department (LCHD) have identified two confirmed cases of influenza A in individuals with exposure to swine at the Fowlerville Family Fair. The fair took place July 23-28, and several pigs from the fair tested positive for swine flu on July 27. Further laboratory testing is underway to determine if the flu viruses found in the swine and the ill persons are the same strain. Additional fair attendees are also reporting influenza-like illness and are being tested.

LCHD, in coordination with the Fowlerville Fair Board, reached out to swine exhibitors, their families and attendees who visited the swine barn at the fair shortly after receiving the test results to notify them of possible exposure to infected pigs. The LCHD also instructed healthcare providers in the area to watch for patients presenting with respiratory symptoms who report exposure to swine or who visited the fair.

“We are urging those who visited the swine barn at the Fowlerville Fair to monitor their health and follow up with their healthcare provider if they start feeling ill,” said Dr. Eden Wells, MDHHS chief medical executive. “It can take up to 10 days for symptoms to appear and some individuals can develop serious complications.”

Symptoms of swine flu in people are similar to the seasonal flu and can include fever, cough, runny nose and sometimes body aches, nausea, vomiting or diarrhea. Sometimes swine flu causes severe disease even in healthy people, such as pneumonia which may require hospitalization, and even death.

Those at higher risk of developing complications if they get swine flu include children younger than five years of age, people 65 years of age and older, pregnant women and people with certain chronic health disease, such as asthma, diabetes, heart disease, weakened immune systems and neurological conditions.

Individuals with health questions can call the LCHD Nurse on Call line at 517-552-6882 and leave your name and phone number and someone will return your call as soon as possible. Healthcare providers with questions about testing options for swine flu can find information on the LCHD website or call 517-552-6882.

Currently, there is no vaccine for swine flu and the seasonal flu vaccine will not protect against swine flu; however, antiviral drugs, such as Tamiflu and Relenza, are effective in treating swine flu. Early treatment works best and may be especially important for people with a high-risk condition.

Steps you can take to protect yourself and prevent the spread of any illness:

  • Refrain from eating or drinking in livestock barns or show rings.
  • Do not take toys, pacifiers, cups, baby bottles, strollers or similar items into pig areas.
  • Anyone who is at high risk of serious flu complications and is planning to attend a fair should avoid pigs and swine barns.
  • Avoid touching your eyes, nose and mouth. Germs spread this way.
  • Avoid contact with pigs if you have flu-like symptoms.
  • If you are sick, stay home from work or school until your illness is over.
  • Avoid close contact with sick people.
  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it and wash your hands.
  • Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
For more information on swine flu, visit the CDC website. 

While it is absolutely true that most people who contract swine variant influenza will experience only mild to moderate illness, and these viruses haven't (so far) developed the ability to spread in an efficient and sustained manner in the community, the CDC takes these outbreaks very seriously.

Serious illnesses have occurred, requiring hospitalization, and a couple of deaths have been reported.  And of course, there is always the possibility that one of these viruses could evolve into being more easily transmissible in humans.
H3N2 Variant:[A/Indiana/08/11] is among the 16 novel viruses currently being  tracked by the CDC's IRAT (Influenza Risk Assessment Tool) Rankings, and while its severity would likely be low-to-moderate, it has the third highest `emergence score' (n=6.0) on their list. 
Since the influenza subtypes that commonly circulate in swine (H1, H2 & H3) are also the same HA subtypes as have caused all of the human pandemics going back 130 years (see Are Influenza Pandemic Viruses Members Of An Exclusive Club?), when swine variant viruses jump to humans, it tend to get our attention.

The CDC's general risk assessment of these swine variant viruses reads:

CDC Assessment

Sporadic infections and even localized outbreaks among people with variant influenza viruses may occur. All influenza viruses have the capacity to change and it’s possible that variant viruses may change such that they infect people easily and spread easily from person-to-person. The Centers for Disease Control and Prevention (CDC) continues to monitor closely for variant influenza virus infections and will report cases of H3N2v and other variant influenza viruses weekly in FluView and on the case count tables on this website

While none of this (at this time) would stop me from attending a county or state fair this summer if I so desired, I would take the warnings and precautions offered by the CDC and public health officials seriously.

Hopefully, county and state fair officials will do so as well. 

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