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Maryland - ​13 people "presumptive" positive for the influenza virus strain H3N2v after contact with pigs at Charles County Fair

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  • Maryland - ​13 people "presumptive" positive for the influenza virus strain H3N2v after contact with pigs at Charles County Fair

    Seven People Get Flu After Contact With Pigs at Charles County Fair


    Seven fair-goers in Maryland have tested positive for a strain of the flu after coming in close contact with pigs at the Charles County Fair, health officials say.

    The Maryland Department of Health said the seven people tested positive for the influenza virus strain H3N2v, or variant flu. None of the infected have been hospitalized or developed serious illness, the health department said.

    ...
    Published at 7:11 PM EDT on Sep 20, 2017

    http://www.nbcwashington.com/news/he...446235663.html

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

    Influenza A detected in swine exhibited at the Charles County Fair
    Further testing taking place to determine specific strain



    Baltimore, MD (September 20, 2017) – The Maryland Department of Health, Maryland Department of Agriculture, and the health departments in Charles County and St. Mary’s County are investigating five cases of influenza in pigs recently exhibited at the Charles County Fair. Preliminary tests show that the pigs are infected with influenza A, but it is not yet known if this strain is potentially transmissible to humans. Additional testing and investigation is underway by the Department of Agriculture.


    It is rare for influenza viruses that normally infect pigs – often called “swine flu” – to spread to people, but it is possible. Most commonly, human infections with swine flu occur in people who have been exposed to infected pigs (e.g., children handling pigs at agricultural fairs or workers in the swine industry). Limited human-to-human spread of swine flu has been detected previously, but no sustained or community spread has been identified. There have been 421 human cases of swine flu in the United States since 2005. Twenty cases have occurred in 2017, all in states other than Maryland.


    The symptoms of swine flu in humans are similar to non-swine influenza and can include fever, cough and sore throat. Prescription influenza antiviral drugs can treat swine flu infections in people, especially when started early. Health officials recommend that people with influenza-like illness contact their healthcare provider and inform them if they have had pig contact within the past seven days. Providers are advised to contact their local health departments if they suspect swine flu in their patients to coordinate appropriate testing with their local health department. The Charles County Health Department can be reached at 301-609-6900 ext. 6025 and the St. Mary’s County Health Department can be reached at 301-475-4330.


    All swine at the Charles County fairgrounds are under a quarantine order from the Department of Agriculture and will not be released until seven days after the last pig shows signs of influenza illness. Swine exhibits at the upcoming St. Mary’s County and Calvert County fairs have been cancelled by order of the Secretary of Agriculture. To report sick pigs, or if you have questions about pigs and influenza, please call the Department of Agriculture at 410-841-5810 or after hours at 410-841-5971.


    Tips to protect yourself and others from the flu
    The flu vaccine protects against many types of influenza. The Centers for Disease Control (CDC) recommends that all people over age 6 months get the flu vaccine every year. Other important steps people can take to protect themselves and others from all types of influenza include:
    • Avoiding close contact with sick people;
    • Limiting contact with others as much as possible if you are sick to keep from infecting them and stay home for at least 24 hours after your fever is gone, except to get medical care or for other necessities;
    • Covering your nose and mouth with a tissue when you cough or sneeze and dispose of the tissue immediately after use;
    • Washing your hands often with soap and water or alcohol-based hand rub if soap and water are not available;
    • Avoiding touching your eyes, nose and mouth; and
    • Cleaning and disinfecting surfaces and objects that may be contaminated with germs like the flu.

    People who are at high risk of serious flu complications, including children younger than 5 years, people 65 years and older, pregnant women, and people with certain long-term health conditions (like asthma and other lung disease, diabetes, heart disease, weakened immune systems, and neurological or neurodevelopmental conditions) should avoid pigs and swine barns. Other people who may have exposure to pigs, such as through an agricultural fair, should take the following protective measures:
    • Do not eat, drink or put anything in your mouth in pig areas;
    • Do not take toys, pacifiers, cups, baby bottles, strollers, or similar items into pig areas;
    • Avoid close contact with pigs that look or act ill;
    • Wear personal protective equipment if you are required to have contact with a pig that is known or suspected to be sick;
    • Wash your hands often with soap and running water or alcohol-based hand rub before and after exposure to pigs;
    • Minimize contact with pigs in the pig barn and arenas;
    • If you have a pig, watch it for signs of illness and call a veterinarian if you suspect illness; and
    • Avoid contact with pigs if you have flu symptoms.

    Additional Resources:
    1. Health overview of flu facts, the Maryland 2016-2017 Influenza Plan, and other flu-related resources:https://phpa.health.maryland.gov/OID...influenza.aspx.
    2. USDA APHIS swine disease information: https://www.aphis.usda.gov/aphis/our...se-information.
    3. CDC information about swine flu, including key facts and details on past cases: https://www.cdc.gov/flu/swineflu/index.htm.
    4. CDC guidance for people attending agricultural fairs or other settings where swine might be present: http://www.cdc.gov/flu/swineflu/vari...dfactsheet.htm.
    5. CDC information about influenza, including prevention recommendations, surveillance data, and other facts: https://www.cdc.gov/flu/index.htm.
    6. World Animal Health Organization (OIE) information: http://www.oie.int/fileadmin/Home/en...ards/SI-EN.pdf.
    7. Maryland Secretary of Agriculture Order to Prevent the Spread of Swine Influenza: http://mda.maryland.gov/AnimalHealth...neFluOrder.pdf.
    https://health.maryland.gov/newsroom...d-at-the-.aspx

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    Testing points to a flu virus in 7 fair-goers who had close contact with swine


    None of those who attended Charles County event is seriously ill with H3N2v


    Baltimore, MD (September 20, 2017) ? The Maryland Department of Health has presumptively identified the influenza virus strain H3N2v (variant flu) in seven Maryland residents who had close contact with pigs at the Charles County Fair. None of the infected individuals has developed serious illness or been hospitalized.


    Influenza is an infection caused by the influenza virus which can affect people and other animals, including pigs and birds. Symptoms for the H3N2v strain are the same as seasonal flu and include fever and respiratory symptoms, such as sore throat and cough. Historically, there is limited human to human transmission from this strain of variant flu. The treatment recommendations for this strain of influenza are the same as for seasonal flu.


    Health officials recommend that people with influenza-like illness contact their healthcare provider and inform them if they have had pig contact within the past seven days. Providers are advised to contact their local health departments if they suspect variant flu in their patients to coordinate appropriate testing with their local health department. The Charles County Health Department can be reached at 301-609-6900 ext. 6025 and the St. Mary?s County Health Department can be reached at 301-475-4330.


    Twenty other cases of variant flu have been detected in other states this year. Of those, 18 were also the virus strain H3N2v. Illnesses associated with these variant flu infections have been mostly mild with symptoms similar to those of seasonal flu. In 2012, 13 individuals developed influenza after direct contact with sick pigs at the Queen Anne?s County fair in Maryland.


    Certain people are at higher risk for complications of influenza, including children under five, the elderly, pregnant women, and those with chronic heart, lung, liver, kidney and neurologic conditions or immunosuppression. The spread of influenza, including the possible spread of H3N2v, between humans can be prevented by:
    • Avoiding close contact with sick people;
    • Limiting contact with others as much as possible if you are sick to keep from infecting them and staying home from work or school if you are sick until you are fever free for 24 hours without fever reducing medicines;
    • Covering your nose and mouth with a tissue when you cough or sneeze and dispose of the tissue immediately after use;
    • Washing your hands often with soap and water or alcohol-based hand rub if soap and water are not available;
    • Avoiding touching your eyes, nose and mouth;
    • Cleaning and disinfecting surfaces and objects that may be contaminated with germs like the flu; and
    • Getting the seasonal influenza vaccine when it becomes available. Although it is not effective against H3N2v, it is protective against other common strains of influenza.

    The spread of influenza between pigs and humans can be prevented by:
    • Washing your hands frequently with soap and running water before and after exposure to pigs;
    • Never eating, drinking or putting things in your mouth in pig areas;
    • Considering avoiding exposure to pigs and swine barns this summer, especially if sick pigs have been identified and if you are high risk of complications from influenza;
    • Watching your pig for signs of illness and calling a veterinarian if you suspect they might be sick;
    • Avoiding close contact with pigs that look or act ill; and
    • Avoiding contact with pigs if you are experiencing flu-like symptoms.

    Additional information from the Centers for Disease Control and Prevention regarding Swine Influenza/Variant Influenza Viruses is available here.


    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

  • #2
    hat tip Michael Coston


    Sunday, September 24, 2017

    Updating The Maryland Swine Variant H3N2v Outbreak


    PDF











    #12,770


    On Thursday, in Maryland DOH: 7 Fairgoers Test Positive For Swine Variant H3N2v, we learned of an outbreak of swine variant influenza among attendees of the Charles County Fair, and the decision to close the swine venues at two upcoming county fairs (Calvert County & St. Mary's).

    The CDC describes Swine Variant viruses in their Key Facts FAQ.
    What is a variant influenza virus?
    When an influenza virus that normally circulates in swine (but not people) is detected in a person, it is called a “variant influenza virus.” For example, if a swine origin influenza A H3N2 virus is detected in a person, that virus will be called an “H3N2 variant” virus or “H3N2v” virus.
    Over the past dozen years we've seen just over 420 swine variant cases (H1N1v, H1N2v, H3N2v) reported by the CDC with 307 coming in just one year (2012). Last year we saw an uptick in cases (see MMWR: Investigation Into H3N2v Outbreak In Ohio & Michigan - Summer 2016), as we have again this summer.

    The 7 cases reported on Thursday have not yet been added to the CDC's total, and a brief notice posted on the Maryland Health Departmentwebsite now indicates the number of presumptive cases has risen to 10.
    Influenza A (H3N2) Variant Virus

    Background

    The Maryland Department of Health has presumptively identified the influenza virus strain H3N2v (variant flu) in Maryland residents who had close contact with pigs at the Charles County Fair. None of the infected individuals has developed serious illness or been hospitalized.


    Influenza is an infection caused by the influenza virus which can affect people and other animals, including pigs and birds. Symptoms for the H3N2v strain are the same as seasonal flu and include fever and respiratory symptoms, such as sore throat and cough. Historically, there is limited human to human transmission from this strain of variant flu. The treatment recommendations for this strain of influenza are the same as for seasonal flu.

    It is recommended that people with influenza-like illness contact their healthcare provider and inform them if they have had pig contact within the past seven days. Providers are advised to contact their local health departments if they suspect variant flu in their patients to coordinate appropriate testing with their local health department. For local health department contact information, visit: https://health.maryland.gov/Pages/departments.aspx​​



    Maryland Cases (as of September 22, 2017)

    10 presumptive positive cases
    In an attempt to better quantify the size of this outbreak, the Maryland Department of Health has issued a letter to clinicians with guidance for testing and reporting. An excerpt from the letter describes when testing is appropriate:
    When to suspect variant influenza virus
    Variant influenza virus infection cannot be distinguished by clinical features from seasonal influenza virus infection, or from infection with other respiratory viruses that can cause influenza-like illness (fever and either cough or sore throat). Therefore, the key to suspecting variant virus infection in an ill patient is to elicit an epidemiological link to recent swine exposure in the 7 days prior to illness onset,specifically:
    • Direct contact with swine (e.g., showing swine, raising swine, feeding swine, or cleaning swine waste); or
    • Close contact (within 2 meters or approximately 6 feet) with an ill person who had recent swine exposure or is known to be infected with a variant virus.
    A weaker epidemiological link would be:
    • Indirect exposure to swine (e.g., visiting a swine farm or walking through a swine barn), especially if swine were known to be ill
    We've seen studies in the past suggesting that only a fraction of cases are ever identified (see CID Journal: Estimates Of Human Infection From H3N2v (Jul 2011-Apr 2012), and while H3N2v is viewed as having only low to moderate pandemic potential, the CDC is always keen to investigate whenever a zoonotic virus like swine H3N2 jumps species.
    While both local and state health departments are reporting no serious illnesses or hospitilzations, several local media outlets are reporting on an 8-year-old girl hospitalized with swine flu after attending Charles County Fair, mother says.
    Normally mild or moderate infections, serious illness and even deaths have occasionally been reported with swine variant viruses (see here, here, and here). Despite a long history of exposure to seasonal H3N2 flu viruses, research has shown only limited community immunity to these variant strains (see CIDRAP: Children & Middle-Aged Most Susceptible To H3N2v).

    Although it may or may not be related to swine variant influenza (tests are pending), late yesterday another fair in Maryland closed their pig barn due to the discovery of a sick pig, and reports of a child hospitalized with flu-like symptoms with prior exposure.

    This report from the CBS-TV affiliate (WJZ) in Baltimore.

    September 23, 2017 11:15 PM

    BALTIMORE (WJZ) — The swine barn at The Great Frederick Fair was shut down Saturday after state inspectors found at least one pig with a 106-degree fever.

    The Frederick News-Post reports that state veterinarian Michael Radebaugh said that a pig at the fair was showing signs of illness, with swine flu as a possible cause.

    The Animal Health section of the Maryland Department of Agriculture closed the barn within an hour of symptoms.

    (SNIP)
    A sick child at Frederick Memorial Hospital was also reportedly showing flu-like symptoms and the fair board was alerted.

    The child’s parents told doctors that they had been at the fair and around pigs.
    We should know more about this incident, and whether it is related to a swine variant virus, in the next few days. While the evidence is still circumstantial, Maryland officials are obviously operating with an abundance of caution.
    With state and county fair season continuing into the fall, it would not be unexpected to see additional, scattered reports of swine variant infection from around the nation.
    H2N2v is the most common swine variant virus reported in the United States, but is far from the only swine flu virus of concern. Co-circulating in North America are also H1N1 and H1N2 swine viruses, along with occasional reassortants like H3N1 (see J. Virol: Novel Reassortant Human-like H3N2 & H3N1 Influenza A Viruses In Pigs).
    Globally the picture becomes even more complicated, with reports of other swine flu variants coming from Europe, South America, and Asia. As surveillance and testing is spotty at best, the constellation of of swine flu viruses in circulation is likely much larger and more complex than we know.
    A few recent blogs on other swine flu threats include:

    Comment


    • #3
      Influenza A Detected in Swine Exhibited at The Great Frederick Fair

      September 24, 2017

      ANNAPOLIS, MD – The Maryland Department of Agriculture, Maryland Department of Health and the Frederick County Health Department are investigating 11 cases of influenza in pigs recently exhibited at The Great Frederick Fair. Preliminary tests show that the pigs are infected with influenza A, but it is not yet known if this strain is potentially transmissible to humans. Additional testing and investigation is underway by the Department of Agriculture.

      All swine at the Frederick County fairgrounds are under a quarantine order from the Department of Agriculture and will not be released until seven days after the last pig shows signs of influenza illness. To report sick pigs, or if you have questions about pigs and influenza, please call the Department of Agriculture at 410-841-5810 or after hours at 410-841-5971.

      It is rare for influenza viruses that normally infect pigs – often called “swine flu” – to spread to people, but it is possible. Most commonly, human infections with swine flu occur in people who have been exposed to infected pigs (e.g., children handling pigs at agricultural fairs or workers in the swine industry). Limited human-to-human spread of swine flu has been detected previously, but no sustained or community spread has been identified.

      The symptoms of swine flu in humans are similar to non-swine influenza and can include fever, cough and sore throat. Prescription influenza antiviral drugs can treat swine flu infections in people, especially when started early. Health officials recommend that people with influenza-like illness contact their healthcare provider and inform them if they have had pig contact within the past seven days. Providers are advised to contact their local health departments if they suspect swine flu in their patients to coordinate appropriate testing with their local health department. The Frederick County Health Department can be reached at 301-600-1733.

      In accordance with the Secretary of Agriculture’s Hold Order (September 19, 2017), all swine exhibitions and any other activities involving swine will remain closed at the St. Mary’s and Calvert county fairs. All other movement or activities involving swine, including slaughter and butchering can proceed as usual.

      Influenza viruses do not affect the safety of properly cooked pork. As with any raw meat, pork should always be properly handled and cooked to eliminate a range of food safety concerns.
      "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
      -Nelson Mandela

      Comment


      • #4
        Influenza A (H3N2) Variant Virus




        Background



        The Maryland Department of Health has presumptively identified the influenza virus strain H3N2v (variant flu) in Maryland residents who had close contact with pigs at the Charles County Fair.

        Influenza is an infection caused by the influenza virus which can affect people and other animals, including pigs and birds. Symptoms for the H3N2v strain are the same as seasonal flu and include fever and respiratory symptoms, such as sore throat and cough. Like seasonal influenza, variant influenza typically causes mild illness. Certain people are at higher risk for complications of influenza, including children under five, the elderly, pregnant women, and those with chronic heart, lung, liver, kidney and neurologic conditions or immunosuppression. These individuals should consider avoiding exposure to pigs and swine barns, especially where sick pigs have been identified.

        Historically, there is limited human to human transmission from this strain of variant flu. The treatment recommendations for this strain of influenza are the same as for seasonal flu.

        It is recommended that people with influenza-like illness contact their healthcare provider and inform them if they have had pig contact within the past seven days. Providers are advised to contact their local health departments if they suspect variant flu in their patients to coordinate appropriate testing with their local health department. For local health department contact information, visit: https://health.maryland.gov/Pages/departments.aspx​​




        Maryland Cases (as of September 25, 2017)

        13 presumptive positive cases







        MDH Press Releases



        H3N2v Detected in Maryland Residents (September 20, 2017)

        Investigation Into Sick Pigs at Charles County Fair (September 20, 2017)







        Guidance for Clinicians



        Variant Influenza Clinician Letter (September 21, 2017)



        CDC Interim Guidance for Clinicians






        https://phpa.health.maryland.gov/Pag...influenza.aspx

        Comment


        • #5
          Heat likely culprit in spread of swine flu at Great Frederick Fair

          By Samantha Hogan and Kate Masters shogan@newspost.com kmasters@newspost.com 11 hrs ago 3
          ...
          One pig has died, and its body will undergo a necropsy at the Animal Health diagnostic laboratory in Frederick. The department still did not know if the animal had died of influenza or other causes as of Monday.

          Despite an earlier report that a child presented to the emergency room at Frederick Memorial Hospital with flu-like symptoms after visiting the fair and swine barns, there have been no suspected or confirmed cases of swine flu so far at the hospital, said Dr. Vipul Kella, medical director of the FMH emergency department on Monday.
          ...
          Locally, though, there has been concern over flu-like symptoms among exhibitors who spent extended time with the swine at the fair. Allie DiRocco, 17, serves as the treasurer of the FFA chapter at Oakdale High School and said she came down with flu-like symptoms on Friday, three days after handing out ribbons to exhibitors at a 4-H and FFA swine market show.
          ...



          "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
          -Nelson Mandela

          Comment

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