Post on 22-Jun-2015
description
Swine influenza: the human animal interface at Minnesota fairs
and live animal markets
Joni Scheftel DVM, MPH, dip ACVPM State Public Health Veterinarian Minnesota Department of Health
joni.scheftel@state.mn.us 651-201-5107
September 16, 2013
History of Swine influenza Infections in Humans in the US
Swine Influenza in People: Previously Rare
• 37 reported cases of swine influenza in humans from 1958-2005, most with swine contact, some with probable person-to-person transmission CID, 2007
• 11 reported cases of triple-reassortant swine influenza A (H1) from 2005-2009, most with swine contact, no known person-to-person transmission NEJM, 2009
Human Infections with SIV in MN • 1996; H1N1; 37 Yr old F; swine contact; fatal • 2008; rH1N1; 29 yr old F; Live animal
market; hospitalized briefly • 2009; rH1N1; 29 yr old F; swine worker • 2010 May; rH3N2; 1 yr old F; Live animal
market • 2010 Dec; rH3N2; 31 yr old M; Live animal
market • 2011; rH1N2; 5 mo-old F; no animal
exposure- sick family member
Swine-Origin Human Influenza Cases by Year and Type, Minnesota, 1996-2012
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f Hospitaliza2
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Year
H1N2 H3N2 H1N1
U.S. Cases of Variant Influenza A through 2012
Confirmed Human Cases of H3N2v in the US, 2012 (N = 306)
Date of onset, 2012
Number cases
4138
6
107 11 20
Slide from Dr. Sue Trock
H3N2v at State and County Fairs in the US
and at the MN State Fair during 2012
Slide thanks to Dr. Sue Trock
States with confirmed cases 11
Fairs associated with human cases 39
Confirmed cases 309
Hospitalized cases 16
Deaths 1
Human H3N2v Influenza Cases 2012, (n= 305)
Slide thanks to Dr. Sue Trock
Summary of Human H3N2v Cases, 2012 • Median age = 6 y.o. (range 4 mo – 74 y.o.)
– 93% less than 18 y.o. • Most cases occurred in young swine exhibitors at county fairs with several days exposure to pigs at a fair – 5% of cases were visitors to a fair
• Incuba2on period ~ 2 – 3 days • Dura2on of illness ~ 3 – 4 days
Slide thanks to Dr. Sue Trock
Distribu2on of H3N2v Cases and Propor2on of Persons with H3N2v HI An2body Titer ≥40 by Age-‐Group*
Slide from Lynn Finelli
CDC and 4-‐H Recommenda2ons, 2012
People at high risk of serious complica2ons from the flu should avoid pigs & swine barns at the fair this year High Risk groups include: < 5 y.o.; asthma, diabetes, lung or heart diseases, or other long-‐term health condi2on; pregnant women; > 65 y.o.
Slide thanks to Dr. Sue Trock
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Num
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f Cas
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Case Onset Date
human H3N2v human probable H3N2v human H1N2v pig H3N2v pig H1N2v
Minnesota State Fair 8/23-‐9/3Minnesota State Fair 8/23-‐9/3Minnesota State Fair 8/23-‐9/3Minnesota State Fair 8/23-‐9/3
H3N2v and H1N2v Cases in Minnesota, 2012
H3
H3
H1 H1 H1
H3
H3 H3
H1
H1 H3
H1
H1 H3
Why Not Minnesota County Fairs in 2012 ?
• The in-office test for influenza doesn’t work for H3N2v
• MDH Health Alert to HCP’s to submit samples to MDH for special testing of cases of influenza-like illness went out to clinics on August 6, after most county fairs had already occurred
• Or maybe the virus didn’t start to circulate among show pigs until later in the summer
Surprises and Things We Learned in 2012
• We were looking for H3N2v in swine exhibitors at the fairs and found it at the Live Animal Markets
• Instead we found H1N2v in pigs and people at the fair first
• These were the first human cases of H1N2v with the pandemic M gene in the US
Good things came out of the experience…
• Great working relationships between BAH, MDA, MDH, State Fair, 4H, U of MN, communications people at all entities
• Know more about the behavior of swine influenza in people and pigs specifically at fairs and potential for interventions
“Be Healthy at the Fair” Verbiage • People and animals can share germs • Wash your hands with soap and water
when you leave the barn • No food or drink in animal areas • Remove pacifiers and avoid hand to
mouth contact • Senior citizens, children under 5,
pregnant women and people with a chronic health condition or a weak immune system should take extra care around animals
Swine Exhibitions Group • Met January 15 and16, 2013 • NASAHO and NASPHV Co-leads
– AASV, CDC, IAFE, USDA, 4H, NPB, Ohio State U, U of MN, Swine Registry, NASAHO, and NASPHV
• Audience: Fair/show organizers and managers, 4H, FFA, Extension personnel, exhibitors and their families, practicing vets, animal health and public health officials
Swine Exhibitions Group
• Developed “Measures that may be considered to minimize transmission of influenza viruses between swine, between people and swine and between swine and people at swine exhibitions” – Prior to the exhibition – At the exhibition – After the exhibition
2013 Healthy Fairs Workshops
2013: Increased surveillance for novel influenza infections
• Sent Health Alert to remind HCP’s to send nasal swabs for influenza testing to MDH from people with ILI who report swine contact
• Set up system for sampling of sick 4H kids at the state fair (same as 2012)
Postcard to 4H Families in the Swine Project
July 12, 2013 Dear Swine Exhibitor and Parents: Just a heads up that there have been cases of influenza in people showing swine or visiting the swine barn at fairs in Indiana. So far, no cases have been identified in Minnesota, but we want to be prepared. As a reminder, if you develop flu-‐like symptoms (cough, sore throat, body aches, runny nose, or fever) within a week of the fair please talk to your doctor and ask to have a nasal swab sent to the Minnesota Department of Health for testing. If you have questions about flu in pigs, please contact the Minnesota Board of Animal Health at 651-‐201-‐6844; if you have questions about the flu in people, please contact the Minnesota Department of Health at 651-‐201-‐5414. For information on measures you can take to keep your pigs healthy before, during, and after the fair, please go to: http://usaha.org/. Sincerely, Beth Thompson, JD, DVM Joni Scheftel, DVM, MPH Senior Veterinarian State Public Health Veterinarian Minnesota Board of Animal Health Minnesota Department of Health
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2005 2006 2007 2008 2009 2010 2011 2012 2013
Cases
Year
U.S. Cases of Variant Influenza A
Swine-Origin Human Influenza Cases by Source of Infection, Minnesota, 1996-Sept 14 2013
7
6
2
1 1
Live Animal Market
Fair
Swine Farm/Industry
Person-to-Person
Unknown