ProMED-mail |

Published Date: 2011-09-06 17:54:46
Subject: PRO/AH/EDR> Influenza (52): (PA), swine-origin H3N2 reassortant, 3 cases
Archive Number: 20110906.2723

INFLUENZA (52): (PENNSYLVANIA), SWINE-ORIGIN H3N2 REASSORTANT, 3 CASES
**********************************************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Mon 5 Sep 2011
Source: PRNewswirw [edited]
http://www.prnewswire.com/news-releases/novel-influenza-a-cases-linked-to-county-fair-pennsylvanians-should-continue-flu-prevention-practices-and-report-flu-like-illness-129260413.html

Novel Influenza-A Cases Linked to County Fair
---------------------------------------------
The Pennsylvania Departments of Health and Agriculture today announced
3 cases of a novel influenza A virus have been identified, and are now
linked to an agricultural fair in southwestern Pennsylvania.

The 1st individual to become ill, announced on Friday (2 Sep 2011),
has fully recovered from the illness. 2 other individuals, confirmed
ill over the weekend, are recovering. All 3 are children who reported
attending the Washington County Agricultural Fair the week of 13-20
Aug 2011.

The cases in Pennsylvania are similar to previous, rare human
infections with swine-origin H3N2 viruses, but are unique in that they
contain a genetic component of the H1N1 virus.

A continuing investigation, which is being jointly undertaken by the
Departments of Health and Agriculture, as well as the Centers for
Disease Control and Prevention (CDC), has not yet uncovered how the
illness was transmitted to the 3 individuals. However, no additional
human infections with this virus have been identified to date.

Anyone who attended the Washington County Fair and has flu-like
symptoms should contact their local health care provider or call the
Pennsylvania Departments of Health. Symptoms would be similar to that
of seasonal influenza, and would include fever, lethargy (extreme
tiredness), lack of appetite and coughing. Other influenza symptoms
may include a runny nose, sore throat, eye irritation, nausea,
vomiting and diarrhea.

The Department of Health [DOH] and the CDC are conducting increased
surveillance and tracking in southwestern Pennsylvania, as well as
setting up informational booths about influenza at agricultural fairs,
while Department of Agriculture is continuing with monitoring the
health of animals at all exhibitions. The Department of Health
continues to urge the public to take everyday precautions to prevent
the spread of respiratory viruses, while the Department of Agriculture
reminds residents to remember to wash your hands after coming into
contact with animals at fairs and in other public venues.

"We're not telling people to avoid public venues or fairs," said
Pennsylvania DOH Secretary Dr. Eli Avila. "But, until we complete our
investigation, we want to make sure that the public is aware and is
taking the proper precautions to protect their health."

Everyday preventative actions against influenza include:

-- Coughing or sneezing into a tissue, your sleeve or elbow (not your
hands);

-- Washing your hands often with soap and water for at least 20
seconds, especially after you cough or sneeze, or using an
alcohol-based hand cleaner;

-- Keeping your hands away from your face -- don't touch your mouth,
hands or eyes;

-- Keeping frequently used surfaces clean; and

-- Staying home from work, school, and social gatherings if you have
flu-like and feverish symptoms to help prevent others from catching
your illness.

For more information, visit http://www.health.state.pa.us.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
<promed@promedmail.org>

[A total of 2 cases of febrile respiratory illness caused by
swine-origin influenza A (H3N2) viruses were identified on 19 Aug 2011
and 26 Aug 2011, and their characterisation has been described in the
ProMED-mail post archived as 'Influenza (51): swine-origin H3N2
reassortant, children 20110902.2685.' One case (case A) was a boy aged
<5 year resident in Indiana. The other (case B) was a girl aged <5
years, resident in Pennsylvania. No epidemiologic link between the 2
cases had been identified, and although investigations were ongoing,
no additional confirmed human infections with this virus has been
reported.

The 3 cases described in the above report from the Pennsylvania
Department of Health are presumed to be case B and 2 new cases. On as
yet circumstantial grounds they are being linked to attendance at the
same agricultural fair, suggesting transmission of the infection from
an animal source, rather than by person-to-person contact. Further
information is awaited.

These viruses are similar to 8 other swine-origin influenza A (H3N2)
viruses identified from previous human infections over the past 2
years, but are unique in that one of the 8 gene segments (matrix [M]
gene) is from the 2009 influenza A (H1N1) virus. The acquisition of
the M gene in the 2 viruses so far characterised indicates that they
are "reassortants" because they contain genes of the swine-origin
influenza A (H3N2) virus circulating in North American pigs since 1998
and the 2009 influenza A (H1N1) virus that might have been transmitted
to pigs from humans during the 2009 H1N1 pandemic.

Although reassortment between swine influenza and 2009 influenza A
(H1N1) viruses has been reported in pigs in the United States, this
particular genetic combination of swine influenza virus segments is
unique and has not been reported previously in either swine or humans,
based on a review of influenza genomic sequences publicly available in
GenBank. Analysis of data submitted to GenBank via the US Department
of Agriculture (USDA) Swine Influenza Virus Surveillance Program
subsequent to this case identified 2 additional influenza A (H3N2)
isolates from swine containing the M gene from the 2009 influenza A
(H1N1) virus. [See also: MMWR Morb Mortal Wkly Rep 2011; 60(early
release)
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm60e0902a1.htm?s_cid=mm60e0902a1_e&source=govdelivery.

The location of Washington County in the state of Pennsylvania can be
found in the maps at:
http://en.wikipedia.org/wiki/Washington_County,_Pennsylvania. -
Mod.CP]

See Also