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      Outbreak of Variant Influenza A(H3N2) Virus in the United States

      research-article
      Author(s): 1 , 1 , 1 , 8 , 1 , 1 , 9 , 1 , 6 , 1 , 15 , 1 , 1 , 7 , 1 , 12 , 12 , 2 , 1 , 12 , 1 , 5 , 2 , 1 , 2 , 13 , 8 , 14 , 1 , 1 , 1 , 13 , 1 , 1 , 10 , 4 , 7 , 1 , 10 , 7 , 10 , 12 , 11 , 6 , 3 , 1 , 8 , 7 , 10 , 1 , 4 , 8 , 1 , 1 , 10 , 1 , 7 , 1 , 2 , 1 , 1 , 1 , 1
      Publication date (Electronic):
      Journal: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
      Publisher: Oxford University Press
      Keywords: influenza, outbreak, pandemic, variant influenza

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          Abstract

          During an outbreak of H3N2v variant influenza, we identified 306 cases in ten states. Most cases reported agricultural fair attendance and/or contact with swine prior to illness. We found no evidence of efficient or sustained person-to-person transmission of H3N2v.

          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 multistate outbreak of an influenza A(H3N2) variant virus (H3N2v) 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 transmission if swine contact was not identified within 4 days prior to illness onset.

          Results.  From 9 July to 7 September 2012, we identified 306 cases of H3N2v in 10 states. The median age of all patients was 7 years. Commonly reported signs and symptoms included fever (98%), cough (85%), and fatigue (83%). Sixteen patients (5.2%) were hospitalized, and 1 fatal case was identified. The majority of those infected 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. Viruses recovered from patients were 93%–100% identical and similar to viruses recovered from previous cases of H3N2v. All H3N2v viruses examined were susceptible to oseltamivir and zanamivir and resistant to adamantane antiviral medications.

          Conclusions.  In a large outbreak of variant influenza, the majority of infected persons reported exposures, suggesting that swine contact at an agricultural fair was a risk for H3N2v 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.

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          Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong

          Christl Donnelly, Azra C. Ghani, Gabriel Leung … (2003)
          Summary Background Health authorities worldwide, especially in the Asia Pacific region, are seeking effective public-health interventions in the continuing epidemic of severe acute respiratory syndrome (SARS). We assessed the epidemiology of SARS in Hong Kong. Methods We included 1425 cases reported up to April 28, 2003. An integrated database was constructed from several sources containing information on epidemiological, demographic, and clinical variables. We estimated the key epidemiological distributions: infection to onset, onset to admission, admission to death, and admission to discharge. We measured associations between the estimated case fatality rate and patients’age and the time from onset to admission. Findings After the initial phase of exponential growth, the rate of confirmed cases fell to less than 20 per day by April 28. Public-health interventions included encouragement to report to hospital rapidly after the onset of clinical symptoms, contact tracing for confirmed and suspected cases, and quarantining, monitoring, and restricting the travel of contacts. The mean incubation period of the disease is estimated to be 6.4 days (95% Cl 5.2–7.7). The mean time from onset of clinical symptoms to admission to hospital varied between 3 and 5 days, with longer times earlier in the epidemic. The estimated case fatality rate was 13.2% (9.8–16.8) for patients younger than 60 years and 43.3% (35.2–52.4) for patients aged 60 years or older assuming a parametric γ distribution. A non-parametric method yielded estimates of 6.8% (4.0–9.6) and 55.0% (45.3–64.7), respectively. Case clusters have played an important part in the course of the epidemic. Interpretation Patients’age was strongly associated with outcome. The time between onset of symptoms and admission to hospital did not alter outcome, but shorter intervals will be important to the wider population by restricting the infectious period before patients are placed in quarantine. Published online May 7, 2003 http://image.thelancet.com/extras/03art4453web.pdf
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            Triple-reassortant swine influenza A (H1) in humans in the United States, 2005-2009.

            Vivek Shinde, Carolyn Bridges, Timothy Uyeki … (2009)
            Triple-reassortant swine influenza A (H1) viruses--containing genes from avian, human, and swine influenza viruses--emerged and became enzootic among pig herds in North America during the late 1990s. We report the clinical features of the first 11 sporadic cases of infection of humans with triple-reassortant swine influenza A (H1) viruses reported to the Centers for Disease Control and Prevention, occurring from December 2005 through February 2009, until just before the current epidemic of swine-origin influenza A (H1N1) among humans. These data were obtained from routine national influenza surveillance reports and from joint case investigations by public and animal health agencies. The median age of the 11 patients was 10 years (range, 16 months to 48 years), and 4 had underlying health conditions. Nine of the patients had had exposure to pigs, five through direct contact and four through visits to a location where pigs were present but without contact. In another patient, human-to-human transmission was suspected. The range of the incubation period, from the last known exposure to the onset of symptoms, was 3 to 9 days. Among the 10 patients with known clinical symptoms, symptoms included fever (in 90%), cough (in 100%), headache (in 60%), and diarrhea (in 30%). Complete blood counts were available for four patients, revealing leukopenia in two, lymphopenia in one, and thrombocytopenia in another. Four patients were hospitalized, two of whom underwent invasive mechanical ventilation. Four patients received oseltamivir, and all 11 recovered from their illness. From December 2005 until just before the current human epidemic of swine-origin influenza viruses, there was sporadic infection with triple-reassortant swine influenza A (H1) viruses in persons with exposure to pigs in the United States. Although all the patients recovered, severe illness of the lower respiratory tract and unusual influenza signs such as diarrhea were observed in some patients, including those who had been previously healthy. 2009 Massachusetts Medical Society
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              Cases of swine influenza in humans: a review of the literature.

              Kenneth Olsen, Linda K Myers, C. G. Gray (2007)
              As the threat of a pandemic looms, improvement in our understanding of interspecies transmission of influenza is necessary. Using the search terms "swine," "influenza," and "human," we searched the PubMed database in April 2006 to identify publications describing symptomatic infections of humans with influenza viruses of swine origin. From these reports, we extracted data regarding demographic characteristics, epidemiological investigations, and laboratory results. We found 50 cases of apparent zoonotic swine influenza virus infection, 37 of which involved civilians and 13 of which involved military personnel, with a case-fatality rate of 14% (7 of 50 persons). Most civilian subjects (61%) reported exposure to swine. Although sporadic clinical cases of swine influenza occur in humans, the true incidence of zoonotic swine influenza virus infection is unknown. Because prior studies have shown that persons who work with swine are at increased risk of zoonotic influenza virus infection, it is prudent to include them in pandemic planning efforts.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Infect Dis
                Journal ID (iso-abbrev): Clin Infect Dis
                Journal ID (publisher-id): cid
                Journal ID (hwp): cid
                Title: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
                Publisher: Oxford University Press
                ISSN (Print): 1058-4838
                ISSN (Electronic): 1537-6591
                Publication date (Print): 15 December 2013
                Publication date (Electronic): 24 September 2013
                Volume: 57
                Issue: 12
                Pages: 1703-1712
                Affiliations
                [1 ] Influenza Division, National Center for Immunization and Respiratory Disease
                [2 ] Epidemic Intelligence Service assigned to the Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
                [3 ] Epidemic Intelligence Service assigned to the Ohio Department of Health, Columbus
                [4 ] Illinois Department of Public Health, Springfield
                [5 ] Epidemic Intelligence Service assigned to the Illinois Department of Public Health, Springfield
                [6 ] Michigan Department of Community Health, Lansing
                [7 ] Minnesota Department of Health, St. Paul
                [8 ] Indiana State Department of Health, Indianapolis
                [9 ] Epidemic Intelligence Service assigned to the Pennsylvania Department of Health, Harrisburg
                [10 ] Pennsylvania Department of Health, Harrisburg
                [11 ] Hawaii Department of Health, Honolulu
                [12 ] Ohio Department of Health, Columbus
                [13 ] Wisconsin Department of Health Services, Madison
                [14 ] West Virginia Bureau for Public Health, Charleston
                [15 ] Maryland Department of Health and Mental Hygiene, Baltimore
                Author notes
                Correspondence: Michael Jhung, MD, MPH, Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS A-32, Atlanta, GA 30333 ( mjhung@ 123456cdc.gov ).
                Article
                Publisher ID: cit649
                DOI: 10.1093/cid/cit649
                PMC ID: 5733625
                PubMed ID: 24065322
                SO-VID: bd4acaff-3069-4ef3-b3c0-d6c22d60aa28
                Copyright © Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013. This work is written by (a) US Government employee(s) and is in the public domain in the US.
                License:

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Date received : 18 June 2013
                Date accepted : 16 August 2013
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                Subject: Articles and Commentaries

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: influenza,outbreak,pandemic,variant influenza
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: influenza, outbreak, pandemic, variant influenza

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