Iowa DPH Reports 3 Novel trH3N2 Cases - human-to-human transmission

[sharon sanders]

hat tip to Michael Coston -

Iowa DPH Reports 3 Novel trH3N2 Cases




# 5973





The Iowa Department of Public Health announced today in a brief press release that they have detected three cases of a novel trH2N2 SOIV (Swine Origin Influenza Virus) described as being similar to the ones reported in Indiana, Pennsylvania, and Maine.



For more on those cases see:



CDC Update On trH3N2 Swine Infections

Maine Confirms A 2nd trH3N2 Case

CDC Update On trH3N2 Cases

A 5th trH3N2 SOIV Report

CDC Update On Recent Novel Swine Flu Cases

MMWR: Swine-Origin Influenza A (H3N2) Virus Infection in Two Children




Unlike the majority of earlier cases reported over the past few months, these three cases report no animal exposure, and so limited Human-to-Human spread is suspected.



My thanks to Carol@SC on the Flu Wiki for posting a news item that led me on search to find this news release from the Iowa DPH.





Flu Activity in Iowa Includes Novel Strain
Posted: Tue, 22 Nov 2011 15:09 CST
Important to cover your cough and stay home when sick
Routine surveillance by the Iowa Department of Public Health (IDPH), the State Hygienic Lab and other partners across the state indicate that a novel strain of the influenza virus has been detected in three children in Webster and Hamilton Counties.
This virus, an influenza A/H3N2 recombinant virus, has also been detected in other states in recent months. Symptoms are similar to the regular seasonal flu and include fever, cough, tiredness, body aches and loss of appetite.This influenza A/H3N2 virus contains components of human, avian, H1N1, and swine influenza.
All spread has been human to human, and spread appears to be limited; no further cases have been identified in the last week. None of the cases have had any animal exposure. Because the virus is unique, IDPH has increased surveillance for this strain at clinics and emergency rooms.

?It appears the seasonal influenza vaccine currently available may offer some protection against this novel strain,? said IDPH Medical Director, Dr. Patricia Quinlisk. ?However, we continue to stress the importance of personal protective actions. Remember the three Cs: Clean you hands frequently; Cover your coughs and sneezes; and Contain germs by staying home when ill.?

No serious illness or death has been reported in connection with this novel influenza A/H3N2 virus, and all cases have recovered. For more information on the virus, visit www.idph.state.ia.us/Cade/Influenza.aspx?pg=FluHome .


While unusual, human infections by novel swine viruses are not unheard of. Over the past 5 years more than 2 dozen (trH1N1 & trH3N2) cases have been detected. Most are a result of direct exposure to swine, although limited human-to-human transmission appears to have occurred.



Since these novel H3N2 infections continue to appear in low levels across the upper Midwest,this is obviously a story we will continue to follow.

Posted by Michael Coston at 5:28 PM

 

[alert]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases

Re: Iowa DPH Reports 3 Novel trH3N2 Cases

Apparently, the three cases may form a cluster, so it remains unclear how much this virus is circulating:

http://www.desmoinesregister.com/article/20111122/NEWS/111122025/1001/?odyssey=nav|head

New flu virus sickens 3 Iowa children

2:48 PM, Nov. 22, 2011 | Comments

Three children in north-central Iowa have been sickened by a new version of the flu virus.


The Iowa Department of Public Health announced this afternoon that the children had tested positive for the A/H3N2 strain of the influenza virus, which has cropped up in several other states this fall. The children are from Webster or Hamilton counties. None needed hospitalization, and all have recovered.


The same strain has sickened seven other Americans - in Pennsylvania, Maine and Indiana.


Dr. Patricia Quinlisk, the department’s medical director, said the new virus is very similar to “A” strains that have been around for years. Because of that, she said, experts believe the current flu vaccine will provide some protection against it.


Quinlisk said she did not believe any of the three Iowa children who became ill had received the vaccine this year. The three children’s names, ages and hometowns were not released, but Quinlisk said one of the children apparently passed the virus to the other two.


more at above link...

 

[alert]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases

Re: Iowa DPH Reports 3 Novel trH3N2 Cases

http://www.mysask.com/portal/site/m...x.portlet.endCacheTok=com.vignette.cachetoken

U.S. sees 3 new infections with new flu virus; looks like person-to-person spread
The Canadian Press
Tue, 22 Nov 2011 16:15:00 CST Share |

Health officials in the United States are reporting three more human infections with a new swine-origin flu virus.

And officials in Iowa, where the cases occurred, say it seems pretty certain the virus was transmitted in these cases from human to human.

State epidemiologist Dr. Patricia Quinlisk says none of the three infected children had any contact with pigs, but they did have contact with each other.

Quinlisk says it seems likely the one child infected the other two, and it's not clear how the first child became infected.

more at above link....

 

[alert]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases

Re: Iowa DPH Reports 3 Novel trH3N2 Cases

At least one other symptomatic contact...

http://www.mysask.com/portal/site/m...x.portlet.endCacheTok=com.vignette.cachetoken

U.S. sees 3 new infections with new flu virus; looks like person-to-person spread
Helen Branswell, The Canadian Press
Tue, 22 Nov 2011 18:50:00 CST Share |



snip


"There's pretty good indications that one child gave it to the other two children," Iowa state epidemiologist Dr. Patricia Quinlisk said in an interview from Des Moines.

"Right now we have every indication that there's person-to-person spread and absolutely no indication whatsoever that there's animal-to-human spread."

The U.S. Centers for Disease Control has confirmed seven previous cases of infection with this virus, a swine-origin influenza A virus of the H3N2 subtype. The earlier cases have been spotted in Maine, Indiana and Pennsylvania. The first case was spotted in July.

Canada has been on the lookout for this new virus. But so far there have been no findings in this country, said Jirina Vlk, communications executive with the Public Health Agency of Canada.

In fact, so far no other country has reported seeing human infections with this particular virus, said Dr. Nancy Cox, head of the CDC's Influenza Division.

Most of the infections have been mild, like regular flu. But three of the cases have required hospitalization. With the exception of one inflection in an adult aged 58, all have been in children under the age of 10.

At this stage it's impossible to know what's going to happen with this virus. It could peter out or continue to cause sporadic infections. Or these cases could be a sign that a new influenza A virus is establishing itself in the human population.

"It possible that the virus is being seeded and is being transmitted in short transmission chains," Cox admitted.

Given what's known about the virus to this point, that may not be cause for major alarm. The virus is a distant cousin of human H3N2 viruses, meaning a significant portion of people probably has some antibodies that would protect against it.

snip


The three children attended a small day-care together. They live in adjacent counties, Webster and Hamilton, in the centre of the state.

One became sick first and appears to have infected the other two. Quinlisk said it's not clear how the first child got infected.

Another child who is a contact of the first child was ill with what may have been influenza prior to the first child's infection, she said. But by the time laboratories had confirmed the cases, that other child had recovered.

more at above link....

 

[Giuseppe]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - likely human-to-human transmission

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - likely human-to-human transmission

Community trasmission - ie infections cases detected through random sampling during sentinel surveillance - of a novel influenza A virus is an event of public health concern and thus covered by the International Health Regulations (IHR) for immediate notification to the WHO and other national and supernational health agencies.

Community transmission also would have an impact on Pandemic Alert Level that could be raised to Phase 3 or 4 according the evaluations of the World Health Organization.

This decision will be based upon the genetic and antigenic characteristics of this novel influenza A (H3N2) virus of swine origin and its clinical pattern of diseases in humans as well as the projected consequences of a possible large outbreaks into economy and society.

At this point this novel A(H3N2) virus seems to be a potential source for a limited or false pandemic (similar to the 'children pandemic' of 1977 when the subtype A(H1N1) reemerged after two decades of silence, causing illness in young people born after its disappearance in 1968/69 when the new subtype A(H3N2) emerged from pandemic.)

(IOH)

 

[Treyfish]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

November 22, 2011
New flu bug shows up in Iowa

MATT MILNERCNHIThe Zope GazetteTue Nov 22, 2011, 03:24 PM CST
OTTUMWA — Iowa flu activity is still sporadic, but health officials raised their eyebrows recently as a new strain moved into the state.

snip

The IDPH says the new virus, named A/H3N2, is a hybrid strain that includes components of human, avian, H1N1 and swine flus. Three children, all from Webster and Hamilton counties, have been diagnosed with the strain. Other states are also seeing the new variant.

more....

:tiphat:http://journalexpress.net/cnhi/x1295782318/New-flu-bug-shows-up-in-Iowa

 

[Treyfish]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

County officials monitor novel flu strain

Three cases in the state so far — two in Hamilton County, one in Webster County; Children most susceptible; flu shots offer ‘some protection,’ health officials say

November 23, 2011

Anne Blankenship - Managing Editor (editor@freemanjournal.net) , The Daily Freeman Journal
<SCRIPT type=text/javascript src="http://s7.addthis.com/js/250/addthis_widget.js?pub=xa-4a71d5be7a6ba8a6"></SCRIPT>
Iowa Department of Public Health officials said Tuesday that a novel strain of the influenza virus has been detected in three children - two in Hamilton County and one in Webster County.
Hamilton County Public Health Administrator Shelby Kroona said a total of seven cases of the strain - identified as the A/H3N2 virus - have been reported throughout the United States.
"The issue with this strain, which is passed from human to human, is that children seem to be more susceptible," Kroona said.
The IDPH said no further cases have been identified this week.
"We have increased our surveillance with a local clinic and Van Diest Medical Center," she said. Webster County officials have also stepped up surveillance.

snip

For more information, contact Hamilton County Public Health at 832-9565.

Contact Anne Blankenship at editor@freemanjournal.net or call 832-4350.:tiphat:http://www.webstercitynews.com/page...icials-monitor-novel-flu-strain.html?nav=5006

 

[Treyfish]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

..The Iowa Department of Public Health said Tuesday that the children had tested positive for the A/H3N2 strain of the influenza virus, which has cropped up in several other states this fall. The children are from Webster or Hamilton counties. None needed hospitalization, and all have recovered.
The same strain has sickened seven people in Pennsylvania, Maine and Indiana.:tiphat:http://www.desmoinesregister.com/ar...th-central-Iowa?odyssey=tab|topnews|text|News

 

[sharon sanders]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Thank you for posting on this important thread.

While Michael Coston has given us permission to post his material in its entirety, some other media outlets have not.

In this climate of using copyright law to silence media, please post snips only.

:tiphat:

 

[sharon sanders]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Also, some of the media reports above reference the current flu vaccine as a good preventative measure for trH3N2. This is not true. That strain is not included in this year's trivalent flu shot.

 

[Missouriwatcher]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Webster and Hamilton Counties have a combined population of around 54,000 and three novel influenza A/H3N2 virus. What are the odds?

 

[Giuseppe]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Also, some of the media reports above reference the current flu vaccine as a good preventative measure for trH3N2. This is not true. That strain is not included in this year's trivalent flu shot.

This misstatement may be due in part to the earlier interviews of some experts and commentary from the World Health Organization and other authoritative sources about the likely existence of immunity against the triple reassortant H3N2 swine origin virus in the portion of population exposed to natural infection during the 1990 decade caused by the human seasonal donor strain A(H3N2) before some of these viruses jumped to pigs and became established pathogens in this species.

Since A(H3N2) is among humans from 1968/69 - when it caused the mildest global influenza pandemic in recent past - most part of population born before 1990 should have a certain level of immunity against the surface antigens (hemagglutinin (H3) and neuraminidase (N2)) present in this swine origin reassortant.

The Iowa isolated seems to be similar to the other viral strains 'triple reassortant' H3N2 detected in other US States during the 2011 and thus possessing the surface glycoproteins from human sesonal strain H3N2, Matrix gene from A(H1N1)pdm09 strain and the other internal sub-units from avian and swine viruses.

The surface glycoproteins are the antigens recognized by human immune system and thus an individual naturally infected by the H3N2 during his/her life with similar antigens has some protection against it.

The dynamic of infections is not clear at this point but since the majority of trH3N2 human cases in the US are children - it is possible that adults are less likely to be spotted by sentinel surveillance because of mild or asymptomatic illness due in part to pre-existing immunity.

The same characteristic may result in a false-pandemic or a 'children pandemic' like the 1977 event when the H1N1 reemerged after twenty years of oblivion.

The precise public health threat that this novel influenza A virus would likely pose is not known at this joint - but the presence of widespread immunity against surface antigens may alter the level of pandemic alert system maintained by the WHO, that in similar cases would have been already reaised from post-pandemic level 1 to pandemic alert levels 3 or 4.

(IOH)

 

[Giuseppe]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

[Source: ProMedMail.org, full page: (LINK). Extract, edited.]

Published Date: 2011-11-23 08:59:55
Subject: PRO/AH/EDR> Influenza (69): USA (IA) swine-origin H3N2 reassortant
Archive Number: 20111123.3430


INFLUENZA (69): USA (IOWA) SWINE-ORIGIN H3N2 REASSORTANT
********************************************************
A ProMED-mail post http://www.promedmail.org
ProMED-mail is a program of the International Society for Infectious Diseases http://www.isid.org


In this posting:
[1] CIDRAP News report
[2] Iowa Department of Health report

******
[1] CIDRAP News report
Date: Tue 22 Nov 2011
Source: CIDRAP (Center for Infectious Disease Research & Policy) News [edited]



Iowa reports 3 novel swine-origin H3N2 cases
--------------------------------------------
Health officials in Iowa announced today [Tue 22 Nov 2011] they have identified novel swine influenza A/H3N2 infections in 3 children, similar to cases that have been identified over the past months in a handful of other states [see ProMED-mail archived postings below].

The Iowa Department of Public Health (IDPH) said in a statement [reproduced below] that routine surveillance turned up the novel virus in Webster and Hamilton counties. The virus is a swine-origin triple-recombinant H3N2 that includes the matrix gene from the 2009 H1N1 virus.

Though patients in other states had animal exposure or a contact who had animal exposure, Iowa's recombinant H3N2 cases appear to have a human-to-human spread component, according to the statement. The IDPH said spread is so far limited, and no other cases have been identified in the past week.

Symptoms are similar to seasonal flu and include fever, cough, tiredness, body aches, and loss of appetite, according to the IDPH. None of the patients were seriously ill, and all have recovered. Dr Patricia Quinlisk, IDPH medical director, said in the statement that the seasonal flu vaccine may offer some protection against the novel strain, and she stressed the importance of personal protective measures such as covering coughs and sneezes and staying home when sick. Because the virus is unique, the IDPH said it is increasing surveillance for it through clinics and emergency rooms.

The cases appear to push the nation's total to 10 triple-recombinant H3N2 cases reported since September [2011]. On 4 Nov 2011 the US Centers for Disease Control and Prevention (CDC) said it confirmed the 6th and 7th cases, in patients in Maine and Indiana. Cases have also been detected in Pennsylvania.

The CDC, however, has said that it doesn't expect the seasonal flu vaccine to protect against the novel strain. However, according to the CDC, swine-origin viruses have shown sensitivity to the antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza), it said.

[Byline: Lisa Schnirring]
--
Communicated by:
ProMED-mail



******
[2] Iowa Department of Health report
Date: Tue 22 Nov 2011
Source: Iowa Department of Health (IDPH) News [edited]



Flu activity in Iowa includes novel strain
------------------------------------------
Routine surveillance by the Iowa Department of Public Health (IDPH), the State Hygienic Lab and other partners across the state indicate that a novel strain of the influenza virus has been detected in 3 children in Webster and Hamilton Counties.

This virus, an influenza A/H3N2 recombinant [reassortant] virus, has also been detected in other states in recent months. Symptoms are similar to the regular seasonal flu and include fever, cough, tiredness, body aches, and loss of appetite.

This influenza A/H3N2 virus contains components of human, avian, H1N1, and swine influenza. All spread has been human to human, and spread appears to be limited; no further cases have been identified in the last week. None of the cases have had any animal exposure. Because the virus is unique, IDPH has increased surveillance for this strain at clinics and emergency rooms.

"It appears the seasonal influenza vaccine currently available may offer some protection against this novel strain," said IDPH Medical Director, Dr Patricia Quinlisk. "However, we continue to stress the importance of personal protective actions. Remember the 3 Cs: Clean you hands frequently; Cover your coughs and sneezes; and Contain germs by staying home when ill."

No serious illness or death has been reported in connection with this novel influenza A/H3N2 virus, and all cases have recovered.

--
Communicated by:
ProMED-mail

The cases in Iowa differ from the previous cases in other states in that the infection has been transmitted from human to human. The majority of cases of infection with this virus have been children. It is unclear whether the 3 children, resident in the adjacent counties of Webster and Hamilton, had direct personal contact. If these children had been vaccinated with the current seasonal influenza vaccine, it is unlikely that that this vaccine would be generally protective against this viral infection, contrary to the IDPH statement.

The state of Iowa can be located on the HealthMap/ProMED-mail interactive map at http://healthmap.org/r/1sHw. A map showing the locations of Webster and Hamilton counties in central Iowa can be accessed at http://www.digital-topo-maps.com/county-map/iowa.shtml. - [Mod.CP]


[…]
​

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[Giuseppe]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

[Source: US Centers for Disease Control and Prevention, full page: (LINK). Edited.]

"Have You Heard?"


Iowa Reports Novel Influenza Infections in Three Children



November 22, 2011


The Iowa Department of Public Health today reported that a ?novel strain of the influenza virus has been detected in three children.? All three of the children were reportedly mildly ill and have recovered. Iowa has increased surveillance for influenza-like-illness to detect any additional cases of infection with this novel virus.

All three patients are young children who were in contact with one another. All cases were detected at the state public health laboratory through virologic surveillance. An investigation is ongoing but no additional cases have been identified.

Testing at CDC has confirmed that these viruses are similar to the swine-origin influenza A (H3N2) viruses identified in three other states. These viruses contain the ?matrix (M) gene segment? from the pandemic 2009 H1N1 virus. This combination of genes was first identified in a person in July.

Since then, several additional human infections with this virus have been detected, bringing the total number of human infections to 10 (Indiana 2, Pennsylvania 3, Maine 2, and Iowa 3). All 10 patients have recovered and the majority of cases had relatively mild illness, although 3 patients were hospitalized.

CDC has reported on the previous infections on its website, in the FluView activity report, and in the Morbidity and Mortality Weekly Report. Links to all previous reports related to this virus are available on the CDC swine influenza website at http://www.cdc.gov/flu/swineflu/index.htm .

These viruses are substantially different from human influenza A (H3N2) viruses, so the seasonal vaccine is expected to provide limited cross-protection among adults and no protection to children. However, laboratory testing so far indicates these viruses are susceptible to the antiviral drugs oseltamivir (Tamiflu?) and zanamivir (Relenza?). CDC recommends these drugs for treatment of seasonal and these swine-origin influenza viruses.

Prior to the three cases in Iowa, most human infections with this virus were associated with exposure to swine.

In Iowa, however, no swine exposure has been identified. At this time, it appears that unsustained human-to-human transmission may have occurred.

These viruses have been reported in swine in several states in the United States. Swine influenza viruses do not spread through contact with pork or pork products. Eating properly handled and cooked pork is safe.

As part of routine preparedness measures to counter possible pandemic threats posed by novel influenza viruses in the event that they gain the ability to spread easily from person-to-person, CDC has developed a candidate vaccine virus and provided it to manufacturers.


These cases will be officially reported in the MMWR and FluView.
​

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[alert]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

The sequences are reportedly at GISAID as follows:

A/Iowa/07/2011 is a 3F collected on 11/14
A/Iowa/08/2011 is a 1M collected on 11/14
A/Iowa/09/2011 is a 2M collected on 11/14

 

[sharon sanders]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - possible human-to-human transmission

I find these profiles in the GISAID EpiFlu database:

A/Iowa/09/2011
Isolate ID: EPI_ISL_99215
Passage: Original
Type: A / H3N2
Collection Date: 2011-11-14
Host: Human
Location: United States / Iowa
Age: 2
Gender: Male
Originating Lab: Iowa State Hygenic Laboratory
Note: Human case of H3N2 SOIV - with an M gene from 2009 H1N1 Pandemic virus.

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

A/Iowa/08/2011
Isolate ID: EPI_ISL_99214
Passage: Original
Type: A / H3N2
Collection Date: 2011-11-14
Host: Human
Location: United States / Iowa
Age: 1 year
Gender: Male
Originating Lab: Iowa State Hygenic Laboratory
Note: Human case of H3N2 SOIV - with an M gene from 2009 H1N1 Pandemic virus.

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

A/Iowa/07/2011
Isolate ID: EPI_ISL_99213
Passage: Original
A / H3N2
Collection Date: 2011-11-14
Host: Human
Location: United States / Iowa
Age: 3 years
Gender: Female
Originating Lab: Iowa State Hygenic Laboratory
Note: Human case of H3N2 SOIV - with an M gene from 2009 H1N1 Pandemic virus.

 

[alert]

Re: Iowa DPH Reports 3 Novel trH3N2 Cases - human-to-human transmission

Hat-tip Ironorehopper.

Looks like two additional symptomatic contacts.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm60d1123a1.htm?s_cid=mm60d1123a1_x

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Dispatch
November 23, 2011 / 60(Dispatch);1-3


On November 20, 2011, CDC confirmed three cases of swine-origin triple reassortant influenza A (H3N2) (S-OtrH3N2) virus infection in children in two counties in Iowa. None of the children were hospitalized, and each has recovered from a mild episode of febrile respiratory illness. All three were in contact with one another, and none had a known recent exposure to swine. No additional human infections with this virus have been detected in Iowa, and no evidence of sustained human-to-human transmission of this S-OtrH3N2 virus exists; surveillance is ongoing.

Eighteen human infections with swine-origin influenza A (H3N2) viruses have been identified since 2009 (1,2). The most recent 10 cases, including the three Iowa cases described in this report, were infections with S-OtrH3N2 viruses containing the matrix (M) gene from the pandemic 2009 influenza A (H1N1) virus (pH1N1). These viruses are considered reassortant viruses between a swine-origin influenza A (H3N2) virus circulating in North American swine and a pH1N1 virus. All cases of human infection with S-OtrH3N2 virus containing the M gene from the pH1N1 virus have occurred in 2011 and have been reported from four states: Pennsylvania (three cases), Maine (two), Indiana (two), and Iowa (three) (3).

Case Reports
Patient A. In the second week of November 2011, patient A, a previously healthy female child, experienced acute onset of influenza-like illness (ILI). Three days after her illness onset (illness day four), she was seen by a health-care provider, who obtained a respiratory specimen and performed a rapid influenza diagnostic test, which was positive. As part of routine influenza surveillance, the respiratory specimen was forwarded to the University of Iowa State Hygienic Laboratory (SHL) for further evaluation. Patient A's brother experienced onset of ILI 1 day before patient A's date of illness onset. Patient A's brother was not tested for influenza but was treated with oseltamivir by a health-care provider and has recovered. During her illness days two and three, patient A was in contact with her father, who subsequently developed ILI 2 days after his most recent contact with patient A. He was not tested for influenza. No other household member has reported respiratory illness. No family member reported exposure to swine before their illness onset. On her illness day one, patient A attended a small gathering of children.

Patients B and C. Patient B is a previously healthy male child who developed ILI 2 days after patient A's first day of illness. He is the sibling of patient C, a previously healthy male child who developed ILI 1 day after patient B's illness onset. Both children were seen by a health-care provider 2 days after patient B's illness onset; rapid influenza diagnostic testing was positive for both patients. As part of routine influenza surveillance, respiratory specimens were forwarded to SHL for further evaluation. The mother of patients B and C reported that no other household member had a respiratory illness and none had been exposed to swine before patient B became ill. On patient A's illness day one, patients B and C attended the same small gathering of children as patient A.

Epidemiologic and Laboratory Investigations
An investigation by the Iowa Department of Public Health (IDPH) determined that the families of patients A, B, and C reported no recent travel or attendance at community events. To date, the only epidemiologic link among patients A, B, and C that has been identified is attendance at a gathering of children on patient A's illness day one. No illnesses were reported among adults or among the five other children who were present at this gathering on that day. No swine exposures have been identified among adults or children attending this gathering. IDPH has detected no increase in absenteeism or reports of respiratory illness in the community where patients A, B, and C reside or in the schools in the community. Enhanced surveillance for ILI has been implemented in health-care facilities in the communities where patients A, B, and C reside. IDPH has instructed health-care providers to obtain respiratory specimens from patients with ILI for influenza diagnostic testing at SHL. Thus far, no additional cases of S-OtrH3N2 infection have been identified, and surveillance data from the state have shown low levels of influenza activity currently and at the time of all these patients' illnesses.

Eight days after patient A's illness onset, real-time reverse transcription--polymerase chain reaction (rRT-PCR) testing of respiratory specimens from patients A, B, and C at SHL indicated possible S-OtrH3N2 influenza virus. At CDC, preliminary rRT-PCR diagnostic results were inconclusive but indicated probable infection with a swine-origin influenza A (H3N2) virus. Subsequent complete genome sequencing at CDC confirmed all three specimens as S-OtrH3N2 with the M gene from the pH1N1 virus. The viruses from these three patients are resistant to amantadine and rimantadine but are expected to be susceptible to the neuraminidase inhibitor drugs oseltamivir and zanamivir based on their genetic sequence. Because these viruses carry a unique combination of genes, little information currently is available regarding the capacity of this virus to transmit efficiently in swine, humans, or between swine and humans.

Reported by
Kari Prescott, Webster County Health Dept, Fort Dodge; Shelby Kroona, MPH, Hamilton County Public Health, Webster City; Patricia Quinlisk, MD, Denyse Gipple, MPH, Ann Garvey, DVM, Iowa Dept of Public Health; Lucy Desjardin, PhD, Sandy Jirsa, Jeff Benfer, MB, Univ of Iowa State Hygienic Laboratory. Thomas Gomez, DVM, Animal and Plant Health Inspection Svc, US Dept of Agriculture. Lyn Finelli, DrPH, Michael A. Jhung, MD, Seema Jain, MD, Lynnette Brammer, MPH, Scott Epperson, MPH, Joseph Bresee, MD, Alexander Klimov, PhD, Shannon Emery, MPH, Stephen Lindstrom, PhD, Susan Trock, DVM, Daniel Jernigan, MD, Nancy Cox, PhD, Influenza Div, National Center for Infectious and Respiratory Diseases; Karen Wong, MD, Adena Greenbaum, MD, Aaron Storms, MD, Shikha Garg, MD, EIS officers, CDC. Corresponding contributor: Michael A. Jhung, mjhung@cdc.gov, 404-639-3747.

Editorial Note
Since July 2011, a total of 10 cases of human infection with S-OtrH3N2 viruses have been identified in the United States, all containing the M gene from the pH1N1 virus. Seven of these 10 cases resulted in mild illness, but three of the infected persons were hospitalized for influenza; all patients have recovered. In all seven earlier cases, exposure to swine was identified in the patient or in a close contact of the patient (4). The lack of known exposure to swine in the three cases described in this report, combined with the known epidemiologic links, suggests that limited human-to-human transmission of this novel influenza virus might have occurred. Transmission of swine-origin influenza A (H3N2) viruses not containing the M gene from the pH1N1 virus to humans from close contact with an infected person has been reported previously and has not resulted in sustained human-to-human transmission (5). Preliminary evidence from the investigation of these cases in Iowa shows no evidence of ongoing transmission among humans. Swine influenza viruses are spread from pig to pig but are not known to spread through human contact with pork or pork products.

Although the vast majority of human infections with animal influenza viruses do not result in human-to-human transmission (6), each case should be investigated fully to ascertain if these viruses are transmitted among humans and to limit further exposure of humans to infected animals, if infected animals are suspected. Such investigations require close collaboration among state, local, and federal public and animal health officials. As part of routine preparedness measures to counter possible pandemic threats posed by novel influenza viruses in the event that they gain the ability to spread easily from person-to-person, CDC has developed a candidate vaccine virus that could be used to produce a human influenza vaccine against these S-OtrH3N2 viruses and has provided this candidate virus to manufacturers.

Although swine exposure was not associated with the three cases described in this report, because most previous cases of human infection with S-OtrH3N2 viruses have occurred in patients who reported swine exposure before illness onset, clinicians should consider swine-origin influenza A virus infection in the differential diagnosis of patients with febrile respiratory illness who have had contact with swine. It is anticipated that commercially available diagnostic tests, including point-of-care rapid tests, will detect infection with the S-OtrH3N2 virus; however, these tests will not differentiate S-OtrH3N2 from seasonal influenza A viruses. Clinicians who suspect swine influenza virus infections in humans should treat with oseltamivir when indicated (7), obtain a nasopharyngeal swab from the patient, place the swab in viral transport medium, and contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory, using the CDC RT-PCR assay cleared by the Food and Drug Administration. CDC requests that state public health laboratories send all suspected novel influenza A specimens, such as these S-OtrH3N2 viruses, to the CDC Influenza Division's Virus Surveillance and Diagnostics Branch Laboratory.

The 2011--12 seasonal influenza vaccine is expected to provide limited protection from this virus for adults but none for young children. Enhanced surveillance, including surveillance for ILI and diagnostic testing of respiratory specimens, is being conducted in Iowa and surrounding states as part of the ongoing investigation of these cases. Additional information about swine influenza is available at http://www.cdc.gov/flu/swineflu.

 

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Re: Iowa DPH Reports 3 Novel trH3N2 Cases - human-to-human transmission

http://www.who.int/csr/don/2011_11_24/en/index.html

Influenza like illness in the United States of America
24 November 2011 - The United States Government has reported three cases of human infection with swine origin triple reassortant Influenza A H3N2. Between 10 and 13 November 2011, three children (aged 11 months, 2 years and 3 years) experienced onset of febrile respiratory illness. All three children had visited the same health care provider in Iowa State. None of them were hospitalized and all three have recovered.

Laboratory testing conducted on 18 November 2011 in the State Hygienic Laboratory at the University of Iowa showed a swine-origin triple reassortant influenza A (H3N2) (S-OtrH3N2) virus. This was confirmed by sequencing at the Centers for Disease Control and Prevention (CDC) on 20 November.

The three children attend the same daycare facility. There is an ongoing investigation and to date, no epidemiological link to swine has been identified in any of the three children. Additional investigation is currently underway to identify and characterize the illness in other daycare attendees, family members, or other contacts, and to determine any exposure to swine.

These are 16th, 17th and 18th cases of human infection with swine origin triple reassortant influenza A (H3N2) detected in the United States since 2009, and the 8th, 9th, and 10th cases reported this year.

WHO is closely following the situation with the US Government, CDC and other partners.

 

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Re: Iowa DPH Reports 3 Novel trH3N2 Cases - human-to-human transmission

Patient A's untested brother was the first to show symptoms but they don't talk much about him.

Patient A's brother experienced onset of ILI 1 day before patient A's date of illness onset. Patient A's brother was not tested for influenza but was treated with oseltamivir by a health-care provider and has recovered.