Update: “Measures to Minimize Influenza Transmission at...
Transcript of Update: “Measures to Minimize Influenza Transmission at...
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Joni Scheftel, DVM, MPH, DACVPMState Public Health Veterinarian
6/21/2018
Update: “Measures to Minimize Influenza Transmission at Swine Exhibitions”
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What is the difference between bird flu and swine flu?
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With bird flu you need tweet-mentand with swine flu you need oink-ment
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Influenza A, a scientific soup
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Influenza A Viruses
• Named by surface proteins H and N
• Hemagglutinin (H1-H18)
• Neuraminidase (N1-N11)
• These represent only 2 of 8-10 genes
• Names can be the same, H5N1, H7N7, etc
• But can be very different viruses depending on lineage, for example human seasonal influenza H3N2 vs. swine influenza virus H3N2
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Current Naming Convention
• When a person is infected with an animal-origin Influenza A virus, it is termed a variant virus infection
• Denoted with a “v” after the subtype
• H3N2v
• The exact same virus when found in a pig or other animal does not carry the “v”
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This is what started it all
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U.S. Cases of Variant Influenza A through 2012
Majority of cases were exhibitors and others with H3N2v infection, who reported contact with pigs at fairs prior to onset of illness
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This is what happened after 2012
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U.S. Cases of Variant Influenza A through 2017
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Confirmed Human Cases of H3N2v in the US,2012 (N = 309)
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H3N2v and H1N2v Cases in Minnesota, 2012
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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
H3
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Surprises and Things We Learned
• We were looking for H3N2v in swine exhibitors at the fairs and found it first at the Live Animal Markets
• Instead we found H1N2v in pigs and people at the fair
• These were the first human cases of H1N2v with the pandemic M gene identified in the US
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Surprises and Things We Learned
• All the pigs with influenza were hold-over pigs
• Came for the 4H show and stayed for the Open Show or the FFA show
• Came for the Open Show and stayed for the FFA show
• Pigs were likely exposed to influenza at the fair and then stayed beyond the 2-4 day incubation period
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Outcomes of MN 2012 Experience
• Great working relationships between BAH, MDA, MDH, State Fair, 4H, U of MN, and the communications people at all entities
• Developed a protocol for influenza surveillance in State Fair swine and 4H exhibitors that we follow today
• Hold-over pigs prohibited at the State Fair
• Agreement on consistent messaging for signage for all state fair buildings
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Swine Exhibitions Group
• Regional H3N2v meeting Oct. 9, 2012
• Supported and organized by NPB
• Swine Exhibitions group met Jan. 15 and 16, 2013
• Supported and organized by CSTE/CDC
• NASAHO and NASPHV Co-leads
• AASV, CDC, IAFE, USDA, 4H, NPB, Ohio State U, U of MN, Swine Registry, NASAHO, and NASPHV
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2013 “Measures” Document
• Basic structure of the document was established
• Suggested measures to minimize transmission of influenza A viruses before, during , and after swine exhibitions
• Premise: Because of the nature of influenza viruses, preventing transmission from pigs to people at exhibitions is heavily dependent upon preventing infection in pigs
• Very different from enteric pathogens with direct and indirect contact transmission
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2013 “Measures” Document
• More questions than answers:
• Efficacy of screening pigs on entry?
• Scientific basis for limiting time at the exhibition to 72 hours?
• How does the virus spread pig-to-pig during shows?
• Unknown, hypothesized to be pen-to-pen
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Efficacy of Screening Pigs on Entry
Andrew S. Bowman, MS, DVM, PhD, DACVPM
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2014: Efficacy of Screening Pigs on Entry: Results
• 3547 snout wipes on day 1 at 9 fairs in IN and OH
• Total of 5.3% of pigs were PCR positive and 1.5% of pigs were positive via virus isolation
• 5 of 9 fairs positive. Among positive fairs: 0.2% to 34% PCR positive and 0.2% to 10.3% positive via virus isolation
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Efficacy of Screening Pigs on Entry: Conclusions
• Frequency of Influenza A isolation from exhibition swine arriving at fairs in the Midwest is low, at 1.5%
• Bowman has also found that most infected pigs are not displaying clinical signs at the time of sample collection
• Taking temperatures at entry not effective
• Control efforts should focus on limiting spread during swine exhibitions rather than attempting to prevent entry of influenza-infected swine
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Evidence for Limiting Time to 72 Hours
Andrew S. Bowman, MS, DVM, PhD, DACVPM
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UNIT ID HERE IN ALL CAPS
DEPARTMENT OF VETERINARY PREVENTIVE MEDICINE
Sampling Methods
Typical timeline of fairs
Weights Shows Sale
Entry Exhibition Period Departure
4-36 hours 3-10 days 4-36 hours
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DEPARTMENT OF VETERINARY PREVENTIVE MEDICINE
Methods
Sample every pig, every day at 8 fairs in 2014, and
repeat in 2015.
Shorten swine exhibitions
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UNIT ID HERE IN ALL CAPS
DEPARTMENT OF VETERINARY PREVENTIVE MEDICINE
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Evidence for Limiting Time to 72 Hours: Results
• 6,810 pigs sampled
• 948 (13.9%) were detected as positive during the course of study.
• IAV was detected in the pigs at 7 (44%) of the 16 fairs
• Sustained IAV transmission at 5 of the 7
• Within those 5 events, the proportion of pigs testing positive for IAV at the conclusion of fairs was 49%.
• If the exhibitions had ended at 72 hours, the proportion of positive pigs would have been <18%.
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Limiting Time to 72 Hours: Conclusions
• Limiting the time that swine are on the fairgrounds may be the most important factor in preventing human variant influenza infections
• Yet may be the most difficult change to effect
• Swine shows have a long, entrenched history and most county fair swine shows have always been held for 5-7 or more days
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How Does Pig-to-Pig Transmission Occur?
Andrew S. Bowman, MS, DVM, PhD, DACVPM
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UNIT ID HERE IN ALL CAPS
DEPARTMENT OF VETERINARY PREVENTIVE MEDICINE
At the fairs with high
initial prevalence, pigs
were first sampled at
weigh-in
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UNIT ID HERE IN ALL CAPS
DEPARTMENT OF VETERINARY PREVENTIVE MEDICINE
Lauterbach SE et al. Emerg Microbes Infect. 2017 Feb 22;6(2):e10.
Weigh-in from 8AM
to 1 PM
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UNIT ID HERE IN ALL CAPS
DEPARTMENT OF VETERINARY PREVENTIVE MEDICINE
Objective:
To document the frequency of IAV contamination of portable fomites at agricultural fairs to identify mitigation strategies for pathogen spread
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DEPARTMENT OF VETERINARY PREVENTIVE MEDICINE
Surface Number tested
PCR
positives/No.
direct contact
surfaces
sampled
PCR positives/No.
indirect contact
surfaces
No. of IAV
isolates
(All from direct
contact surfaces)
Tack Box 80 11/55 (20.4%) 5/25 (20%) 1 (H3N2)
Sort Panel 78 10/43 (23.3%) 2/35 (5.7%) 0
Waterer 82 19/82 (23.2%) 0 3 (H3N2)
Feeder 86 20/86 (23.3%) 02 (H3N2)
1 (H1N1)
Chair 65 2/18 (11.1%) 4/47 (8.5%) 0
Feed Container 2 1/1 (100%) 0/1 (0%) 0
Broom 1 1/1 (100%) 0 0
Fan 2 0 0/2 (0%) 0
Cooler 1 0/1 (0%) 0 0
Pick 1 0 0/1 (0%) 0
Wheelbarrow 1 0/1 (0%) 0 0
Watering Can 1 0 0/1 (0%) 0
Total 400 64/288 (22.3%) 11/112 (9.8%)
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Pig-to-Pig Transmission: Key Findings
• IAV was detected with PCR on 18.75% of inanimate surfaces
• ≥1 surface tested positive at 50% of the fairs (8 Indiana and 2
Ohio fairs)
• Within positive fairs, frequency of IAV detection ranged from
5% to 90%; mean = 37.5%
• Viable IAV was recovered from 7 surfaces across 4 fairs
• 85% of virus isolation positive surfaces were plastic
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Pig-to-Pig Transmission: Conclusions
• Corralling pigs for weighing, tagging, and other activities, with contamination of chutes and other equipment, likely enhances spread of influenza at exhibitions
• Better explains observed pattern of infection than pen-to-pen
• Cleaning and disinfection of surfaces and equipment during an exhibition is very important
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Measures to Minimize Survey
Andrew S. Bowman, MS, DVM, PhD, DACVPM
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Measures to Minimize Survey
• Approximately 150 surveys were collected from jackpot swine exhibitors regarding their perceptions and behaviors related to recommendations in the “Measures to Minimize Influenza Transmission at Swine Exhibitions” document
• 18 states represented
• Average number of shows respondents plans to attend in 2017 = 11
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UNIT ID HERE IN ALL CAPS
DEPARTMENT OF VETERINARY PREVENTIVE MEDICINE
Good
Recommendation
Could
Implement
Already Has
Implemented
Clean and disinfect all tack, feeders, waterers, and show supplies between
shows98% 93% 51%
Wash your hands with soap and water when you leave the barn. 96% 92% 75%
No food or drink in animal areas. 67% 66% 21%
Allow at least 7 days of “down time” (i.e. on-farm quarantine) after
returning from a previous show before showing a pig or pen-mates, to
reduce the risk of spreading influenza. - DOWNTIME80% 65% 58%
Allow at least 7 days of “down time” (i.e. on-farm quarantine) after
returning from a previous show before showing a pig or pen-mates, to
reduce the risk of spreading influenza. - ISOLATION
85% 69% 50%
Discuss the use of swine influenza vaccines with a veterinarian and check
the show rules for any requirements. 95% 92% 83%
Measures to Minimize Survey
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UNIT ID HERE IN ALL CAPS
DEPARTMENT OF VETERINARY PREVENTIVE MEDICINE
Good
Reccomendation
Could
Implement
Already Has
Implemented
Consult a veterinarian to help outline and implement applicable biosecurity
and swine health practices at home.96% 92% 89%
Sick pigs and sick people need to stay home so they do not risk infecting
other pigs or people.98% 92%
77% -Pigs
60% - People
Avoid sharing tack with other exhibitors, but if you must, clean and disinfect
in-between uses.87% 83% 53%
No sleeping in animal areas. 75% 66% 53%
Report sick pigs to exhibition organizers. 89% 84% 43%
Become familiar with the clinical signs of influenza and other illnesses in
pigs.
99% 94% 71%
Measures to Minimize Survey
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Measures to Minimize Survey: Results
• No-one had heard of the document
• Not surprising!
• Most of the recommendations were considered “Good” and could be implemented, but hadn’t yet been implemented
• Public health recommendations had the least uptake
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Measures to Minimize Checklist New in 2018
• Developed to increase accessibility
• Maintains the before/during/after the exhibition format
• Includes checklist of actions to take in case of an outbreak
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Measures to Minimize: New in 2018
• Reorganized and shortened
• Stronger language around measures for which there is supporting evidence
• 72 hours
• Efforts to limit spread of influenza during the fair
• Cleaning and disinfection guidance
• Biosecurity measures
• More emphasis on exhibitor meetings and dissemination of information
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Measures to Minimize: New in 2018
• Enhanced “Measures to Consider if there is an Outbreak in Pigs or People”
• Limit access to pigs and the barn area to people at high risk
• Additional signage should warn people about the occurrence of influenza and the increased risk of serious illness for persons in high risk groups
• Personal protective equipment guidance
• Section for state animal and public health officials
• Human and pig testing guidance
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Questions?