Avian Flu Diary: Indiana Reports 4 H3N2v Infections

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Last Sunday in A Variant Swine Flu Review I wrote about the upcoming county and state fair season (which started in mid-June) and the possibility of seeing a repeat of last year’s swine variant influenza infections among fair goers.

During the summer and early fall of 2013, more than 300 people – mostly linked to county and state fairs in the Mid-West - were diagnosed with one of three swine variant flu strains (H1N1v, H1N2v, and H3N2v).

Today, we’ve the first report of 2013 of the H3N2v influenza detected in 4 fairgoers who recently attended the Grant County fair in Indiana. First the Press Release from the Indiana Department of Health, and then I’ll return with a bit more.

Health Officials Encourage Hoosiers to Protect Themselves From Swine Flu

INDIANAPOLIS—State health officials are encouraging Hoosiers to take steps to protect themselves at county and 4H fairs around the state this summer following detection of four cases of variant influenza A (H3N2v). All individuals visited the Grant County Agricultural Fair, June 16-22, prior to illness, and at least two had contact with swine. Variant influenza A H3N2v was identified in Indiana last year, with a total of 138 cases in 2012.

The Indiana State Department of Health and the Grant County Health Department continue to investigate these cases. Human infections with H3N2v are rare but have most commonly occurred after 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.

According to the State Board of Animal Health, thirteen pigs at the fair tested positive for H3N2. It is not uncommon for pigs to be infected with swine influenza viruses but not show any signs of illness. If ill with influenza they typically recover.

“Fairs are a great way to get outdoors, have some fun and learn about agriculture,” said State Health Commissioner William VanNess, M.D. “If you plan to attend a fair this summer, just be sure to wash your hands frequently and avoid taking food into areas where animals are kept.”

Symptoms of variant influenza A include: fever, cough, sore throat, chills, headache and muscle aches. Diarrhea and nausea may occur in children. Symptoms can begin approximately one to four days after being exposed to the illness and last from two to seven days.

As several county fairs will open in the next few weeks, State health officials are increasing surveillance for influenza-like illness.

“We are increasing our surveillance so we can learn more about this virus and because antiviral treatment is most effective if given within 48 hours,” said Dr. VanNess. “It’s important to contact your health care provider if you begin experiencing flu-like symptoms.”

And if you have visited a fair or been around animals, let your health care provider know. Influenza antiviral drugs can treat infection with H3N2v and quick treatment is especially important for people who are at high risk of serious flu complications, including the very young, the elderly, people with chronic health conditions like asthma, diabetes and heart disease and pregnant women.

Visiting animal exhibits is fun and educational, and Hoosiers are reminded to follow some simple safety steps to prevent illness. 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 and avoid face-to-face contact with animals. People at high risk for flu complications should avoid close contact with swine in the fair setting particularly.

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.

Since there is no vaccine available for people to protect against this H3N2v virus, the best way to prevent infection with variant influenza is to avoid sources of exposure to the virus. As always good hygiene and other everyday preventive actions are important to take as well. Wash your hands frequently. Cough or sneeze into your sleeve or elbow. Avoid contact with people or animals that are ill. Stay home if you develop influenza symptoms and contact your health care provider.

In 2012, the Centers for Disease Control and Prevention (CDC) reported 309 infections with H3N2v in the United States. According to the CDC, most of these infections resulted in mild illness, though 16 people were hospitalized and one person died. Most of the people who were hospitalized and the person who died had one or more high risk conditions.

For more information about variant influenza A, visit www.StateHealth.in.gov or follow the Indiana State Department of Health on Twitter at @StateHealthIN and on Facebook at www.facebook.com/isdh1.

The CDC’s Assessment of the risks from these swine variant flu strains reads:

CDC Assessment

It's possible that sporadic infections and even localized outbreaks among people with this virus will continue to occur. While there is no evidence at this time that sustained human-to-human transmission is occurring, all influenza viruses have the capacity to change and it's possible that this virus may become widespread.

So far, Illness associated with H3N2v infection so far has been mostly mild with symptoms similar to those of seasonal flu. Like seasonal flu, however, serious illness, resulting in hospitalization and death is possible.

People at high risk of serious complications from H3N2v include children younger than 5, people with certain chronic conditions like asthma, diabetes, heart disease, weakened immune systems, pregnant women and people 65 years and older. Limited serologic studies indicate that adults may have some pre-existing immunity to this virus while children do not. Most cases of H3N2v infection have occurred in children who have little immunity against this virus.

While fairs have instituted inspections for any signs of illness in livestock – as we discussed last October (see Asymptomatic Pigs: Revisited) – tests indicate that pigs can carry these viruses without showing any outward signs of infection.

The CDC maintains an H3N2v and You FAQ page, and offers the following advice for fairgoers and exhibitors.

Preventive Actions

CDC Recommendations For People At High Risk:

If you are at high risk of serious flu complications and are going to a fair where pigs will be present, avoid pigs and swine barns at the fair this year. This includes children younger than 5 years, people 65 years and older, pregnant women, and people with certain long-term health conditions (like asthma, diabetes, heart disease, weakened immune systems, and neurological or neurodevelopmental conditions).

If you are not at high risk, take these precautions:

Don’t take food or drink into pig areas; don’t eat, drink or put anything in your mouth in pig areas.

Don’t take toys, pacifiers, cups, baby bottles, strollers, or similar items into pig areas.

Wash your hands often with soap and running water before and after exposure to pigs. If soap and water are not available, use an alcohol-based hand rub.

Avoid close contact with pigs that look or act ill.

Take protective measures if you must come in contact with pigs that are known or suspected to be sick. This includes minimizing contact with pigs and wearing personal protective equipment like protective clothing, gloves and masks that cover your mouth and nose when contact is required.

To further reduce the risk of infection, minimize contact with pigs and swine barns.