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Clin Infect Dis. Outbreak of Variant Influenza A (H3N2v) Virus in the United States

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  • Clin Infect Dis. Outbreak of Variant Influenza A (H3N2v) Virus in the United States

    [Source: Clinical Infectious Diseases, full text: (LINK). Abstract, edited.]


    Outbreak of Variant Influenza A (H3N2v) Virus in the United States


    Michael A. Jhung 1, Scott Epperson 1, Matthew Biggerstaff 1, Donna Allen 9, Amanda Balish 1, Nathelia Barnes 1, Amanda Beaudoin 10, LaShondra Berman 1, Sally Bidol 7, Lenee Blanton 1, David Blythe 16, Lynnette Brammer 1, Tiffany D'Mello 1, Richard Danila 8, William Davis 1, Sietske de Fijter 13, Mary DiOrio 13, Lizette O. Durand 2, Shannon Emery 1, Brian Fowler 13, Rebecca Garten 1, Yoran Grant 6, Adena Greenbaum 2, Larisa Gubareva 1, Fiona Havers 2, Thomas Haupt 14, Jennifer House 9, Sherif Ibrahim 15, Victoria Jiang 1, Seema Jain 1, Daniel Jernigan 1, James Kazmierczak 14, Alexander Klimov 1, Stephen Lindstrom 1, Allison Longenberger 11, Paul Lucas 4, Ruth Lynfield 8, Meredith McMorrow 1, Maria Moll 11, Craig Morin 8, Stephen Ostroff 11, Shannon L. Page 13, Sarah Y. Park 12, Susan Peters 7, Celia Quinn 3, Carrie Reed 1, Shawn Richards, Joni Scheftel 8, Owen Simwale 11, Bo Shu 1, Kenneth Soyemi 4, Jill Stauffer 9, Craig Steffens 1, Su Su 1, Lauren Torso 11, Timothy M. Uyeki 1, Sara Vetter 8, Julie Villanueva 1, Karen K. Wong 2, Michael Shaw 1, Joseph S. Bresee 1, Nancy Cox 1, and Lyn Finelli 1

    Author Affiliations: <SUP>1</SUP>Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention <SUP>2</SUP>Epidemic Intelligence Service assigned to Influenza Division, Centers for Disease Control and Prevention <SUP>3</SUP>Epidemic Intelligence Service assigned to the Ohio Department of Health <SUP>4</SUP>Illinois Department of Public Health <SUP>5</SUP>International Association of Fairs and Exhibitions <SUP>6</SUP>Epidemic Intelligence Service assigned to the Illinois Department of Public Health <SUP>7</SUP>Michigan Department of Community Health <SUP>8</SUP>Minnesota Department of Health <SUP>9</SUP>Indiana State Department of Health <SUP>10</SUP>Epidemic Intelligence Service assigned to the Pennsylvania Department of Health <SUP>11</SUP>Pennsylvania Department of Health <SUP>12</SUP>Hawaii Department of Health <SUP>13</SUP>Ohio Department of Health <SUP>14</SUP>Wisconsin Department of Health Services <SUP>15</SUP>West Virginia Bureau for Public Health <SUP>16</SUP>Maryland Department of Health and Mental Hygiene

    Corresponding Author: Michael Jhung, MD, MPH, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A-32, Atlanta, GA 30333, Phone: 404-639-4128 FAX: 404-639-3866, Email: MJhung@cdc.gov

    Alternate Corresponding Author: Lyn Finelli, DrPH, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE MS A-32, Atlanta, GA 30333, Phone: 404-639-2554 FAX: 404-639-3866, Email: lyf8@cdc.gov


    Abstract

    Background.

    Variant influenza virus infections are rare but may have pandemic potential if person-to-person transmission is efficient. We describe the epidemiology of a multi-state outbreak of an influenza A H3N2v virus first identified in 2011.


    Methods.

    We identified laboratory-confirmed cases of H3N2v and used a standard case report form to characterize illness and exposures. We considered illness to result from person-to-person H3N2v virus transmission if swine contact was not identified within 4 days prior to illness onset.


    Results.

    From July 9—September 7, 2012, we identified 306 cases of H3N2v in ten states. The median age of all cases was 6 years. Commonly reported signs and symptoms included fever (98%), cough (84%), and fatigue (83%). Sixteen cases (5.2%) were hospitalized, and one fatal case was identified. The majority of cases reported agricultural fair attendance (93%) and/or contact with swine (95%) prior to illness. We identified 15 cases of possible person-to-person transmission of H3N2v virus. Viruses recovered from cases were 93% to 100% identical and similar to viruses recovered from previous cases of H3N2v. All H3N2v viruses examined were susceptible to the oseltamivir and zanamivir and resistant to adamantane antiviral medications.


    Conclusion.

    In a large outbreak of variant influenza, the majority of cases reported exposures suggesting swine contact at an agricultural fair was a risk for H3N2v virus infection. We identified limited person-to-person H3N2v virus transmission, but found no evidence of efficient or sustained person-to-person transmission. Fair managers and attendees should be aware of the risk of swine-to-human transmission of influenza viruses in these settings.


    Received June 18, 2013. Accepted August 16, 2013.

    Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013.


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