Rhiza Labs FluTracker Forum

Published Date: 2011-11-24 10:55:52
Subject: PRO/AH/EDR> Influenza (70): USA (IA) swine-origin H3N2 reassortant
Archive Number: 20111124.3438

INFLUENZA (70): USA (IOWA) SWINE-ORIGIN H3N2 REASSORTANT
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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Wed 23 Nov 2011Source: CDC. MMWR Morb Mortal Wkly Rep 2011; 60 (dispatch); 1-3[edited]http://www.cdc.gov/mmwr/preview/mmwrhtml/mm60d1123a1.htm?s_cid=mm60d1123a1_e&source=govdelivery


Limited human-to-human transmission of novel influenza A (H3N2) virus
- Iowa
----------------------------------------------------------------------
On 20 Nov 2011 CDC confirmed 3 cases of swine-origin triple
reassortant influenza A (H3N2) (S-OtrH3N2) virus infection in children
in 2 counties in Iowa. None of the children were hospitalized, and
each has recovered from a mild episode of febrile respiratory illness.
All 2 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.

In total, 18 human infections with swine-origin influenza A (H3N2)
viruses have been identified since 2009 (1,2). The most recent 10
cases, including the 3 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 4 states: Pennsylvania (3 cases), Maine (2), Indiana (2), and
Iowa (3) (3).

Case reports
------------
Patient A: in the 2nd week of November 2011, patient A, a previously
healthy female child, experienced acute onset of influenza-like
illness (ILI). 3 days after her illness onset (illness day 4), 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 one 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 2
and 3, 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 1st day of illness. He is the
sibling of patient C, a previously healthy male child who developed
ILI one 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 5 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 3 specimens as S-OtrH3N2 with
the M gene from the pH1N1 virus. The viruses from these 3 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.

MMWR 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 3 of the infected persons were hospitalized for
influenza; all patients have recovered. In all 7 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 3 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 3 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.

References
----------
1. CDC. Update: influenza activity - United States, 2010-11 season,
and composition of the 2011-12 influenza vaccine. MMWR 2011; 60:
705-12. Available at
http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm6021a5_w.
2. CDC. Update: influenza activity - United States, 2009-10 season.
MMWR 2010; 59: 901-8. Available at
http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm5929a2_w.
3. CDC. FluView: 2011-2012 influenza season week 45 ending 12 Nov
2011. Available at http://www.cdc.gov/flu/weekly. Accessed 23 Nov
2011.
4. CDC: Swine-origin influenza a (H3N2) virus infection in two
children - Indiana and Pennsylvania, July-August 2011. MMWR 2011; 60:
1213-5. Available at
http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm6035a6_w.
5. Robinson JL, Lee BE, Patel J, et al: Swine influenza (H3N2)
infection in a child and possible community transmission, Canada.
Emerg Infect Dis 2007; 13(12): 1865-70. Available at
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876760.
6. Myers KP, Olsen CW, Gray GC: Cases of swine influenza in humans: a
review of the literature. Clin Infect Dis 2007; 44(8): 1084-8.
Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1973337.
7. CDC: Antiviral agents for the treatment and chemoprophylaxis of
influenza -- recommendations of the Advisory Committee on Immunization
Practices (ACIP). MMWR 2011 ;60(No. RR-1). Available at
http://www.cdc.gov/mmwr/preview/mmwrhtm ... rr6001a1_w.

--
Communicated by:
ProMED-mail


[In summary, this report describes the investigation of the 3
confirmed cases of human infection with S-OtrH3N2 virus in Iowa
associated with limited person-to-person transmission. It provides
details not available in the earlier reports, namely, the infections
occurred among children in contact with one another, and all cases
were mild and self-limited. No child had known exposure to swine. The
viruses identified are similar to 7 previous cases reported in 2011,
but these are the 1st cases reported from Iowa.

Swine influenza viruses have been reported sporadically to infect
humans. In the United States, 7 cases of swine-origin triple
reassortant influenza A (H3N2) (S-OtrH3N2) virus infection have been
reported in 2011. Cases have usually occurred after exposure to
swine.

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.

The 2011-12 seasonal influenza vaccine is expected to provide limited
protection from this virus for adults but none for young children. -
Mod.CP]


See Also

Influenza (69): USA (IA) swine-origin H3N2 reassortant 20111123.3430
Influenza (68): Hong Kong swine-origin H3N2 reassortant 20111119.3411
Influenza (66): USA swine-origin H3N2 reassortant, update
20111105.3298
Influenza (63): USA (ME, NOT NH) swine-origin H3N2 reassortant
20111102.3260
Influenza (60): USA (ME) swine-origin H3N2 reassortant 20111021.3134
Influenza (54): (PA) swine-origin H3N2 reassortant, comment
20110913.2789
Influenza (52): (PA), swine-origin H3N2 reassortant, 3 cases
20110906.2723
Influenza (51): swine-origin H3N2 reassortant, children 20110902.2685
Influenza (40): H3N2/H1N1 reassortant ex patient 20110609.1749]
.................................................cp/mj/lm

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Indiana covering IA outbreak in its week 46 report

Routine influenza surveillance in Iowa indicated a novel influenza virus in three children in North Central Iowa. This influenza A (H3N2) recombinant virus has also been detected in other states in recent months. The virus contains components of human, avian, and swine influenza viruses, as well as components of influenza A (H1N1) virus. All transmission has been human-to-human, and transmission appears to be limited. No additional cases have been identified in the last week. None of the ill persons has had any known exposure to animals. No serious illnesses or deaths associated with this novel influenza A (H3N2) virus have been reported, and all ill persons have recovered. Surveillance for this virus has been enhanced at clinics and emergency rooms in the area.

Two human infections with novel influenza A viruses were detected in individuals from Indiana. Both patients were infected with swine-origin influenza A (H3N2) viruses. Both were hospitalized but have been discharged and both have recovered from their illnesses. One case was hospitalized in July, 2011 and one in October, 2011. There has been no evidence of an epidemiological link between these two patients and no sustained human-to-human transmission of these viruses has been found.

http://www.in.gov/isdh/files/Week46-2011.pdf

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Week 46 report
http://www.idph.state.ia.us/IDPHChannel ... 448D1F1A0D

Influenza activity is increasing in Iowa. There have been six laboratory confirmed cases of influenza identified since October.
This includes three cases of a novel influenza strain in children in Webster and Hamilton counties. This virus, an influenza A/H3N2 recombinant virus, has also been detected in Pennsylvania, Maine, and Indiana in recent months and contains components of human, avian, H1N1, and swine influenza. All spread in Iowa has been human to human, and spread appears to be limited; no further cases have been identified in the last week. Symptoms are similar to regular seasonal flu. Because the virus is unique, surveillance has been increased at clinics and emergency rooms in the area.

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State health officials say a new flu strain has been found during routine surveillance in Iowa and that the three people who became ill with the virus have all recovered.

The Iowa Department of Public Health says the A/H3N2 virus was detected in three children in Webster and Hamilton counties. It also has been found in other states in recent months but its spread appears to be limited with no new cases being identified in the past week.

Because the virus is unique, health officials have increased surveillance for the strain at clinics and emergency rooms.

Symptoms are similar to the regular flu virus and include fever, cough, fatigue and body aches.

State Medical Director Dr. Patricia Quinlisk says the seasonal flu vaccine that is available may offer some protection.

Read more: http://www.foxnews.com/health/2011/11/2 ... z1ejuQbLF6

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U.S. health officials remain on the alert for additional cases of a new swine flu strain that infected three Iowa children this month.

Since July, 10 Americans have been sickened by S-OtrH3N2 viruses that picked up a gene from the 2009 H1N1 swine flu pandemic, the federal Centers for Disease Control and Prevention reported. The new flu strain combines a rare influenza virus (H3N2) circulating in North American pigs and the H1N1 virus from the 2009 outbreak. New flu strains develop when flu viruses combine in new ways. They can pose health risks because people haven’t yet developed immunity to them.

Of the other seven cases of the new swine flu, three occurred in Pennsylvania, two in Maine and two in Indiana, the CDC reported in a Wednesday dispatch in its Morbidity and Mortality Weekly Report. In all of those cases, either the patients or close contacts had been recently exposed to pigs. The lack of pig exposure in the three newest cases suggested that the new virus may involve limited person-to-person contact. As part of routine preparedness to counter pandemic threats from new flu viruses, CDC said it had developed a “candidate vaccine virus” that could be used to make a human vaccine against S-OtrH3N2 viruses and has sent it to vaccine manufacturers.

One of the three Iowa children, a previously healthy girl referred to as Patient A, became sick during the second week of November. Her doctor tested her as part of routine surveillance and sent a respiratory sample to the Iowa state laboratory for further analysis. Patient B, a boy, developed a flu-like illnesses two days after the Patient A became ill. A day after Patient B became sick, his brother, Patient C, also became ill. Both tested positive for swine flu. All three children had attended the same small gathering on the first day Patient A was fell ill.

After a detailed investigation, Iowa epidemiologists determined that the gathering was the only common link among the three children’s illnesses. None of their families had recently traveled or attended community events, and none of the three or their families had been exposed to pigs, according to the CDC.

Eight days after Patient A became ill, Iowa state laboratory testing indicated the three might have S-OtrH3N2 influenza. The CDC subsequently confirmed the three youngsters had that strain, which included the so-called matrix (M) gene from the 2009 H1N1 pandemic. The new flu strain is resistant to two commonly used antiviral drugs, rimantidine and amantadine, but based upon their genetic structure, would likely respond to osteltamivir (Tamiflu) and zanamivir (Relenza).

CDC scientists said they expected this years’ seasonal flu vaccine to provide adults with limited protection from the new flu virus, but that it wouldn’t help children. They recommended that doctors who suspect swine flu infections in their patients treat them with Tamiflu where appropriate, obtain nose and throat specimens and send them to a state public health labs, which should report them to CDC. CDC also encourages anyone who has contact with pigs and develops a flulike illness to be tested.

http://abcnews.go.com/blogs/health/2011 ... lu-strain/

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WHO confirms three cases of influenza A (H3N1) in U.S. children





25.11.11 | 13:11 am EUROPE PRESS | MADRID


The United States has recorded three cases of influenza A (H3N1), a subtype of influenza A virus generated by different A (H1N1), but with demonstrations and similar symptoms, as reported by the World Health Organization (WHO).


The infection was detected in children aged 11 months, two and three years old, respectively, between 10 and Nov. 13 last experienced the first symptoms of this disease. The three, who are already recovered, visited the same health center in Iowa, and none was hospitalized.

U.S. health officials have opened an investigation into this matter but, for now, no epidemiological links have been found in pigs, which are the origin of this disease in any of the three children.

However, additional research is already conducted to see if they have contracted the disease, caregivers, families or others in contact with patients and to determine whether there was exposure to pigs.

Since 2009, U.S. cases have been detected number 16, 17 and 18 of infection with A (H3N2) and only this year in this country have been the eighth, ninth and tenth case of this disease.

"WHO is monitoring the situation, worked with the U.S. government and the National Centers for Health, among others," they conclude.

http://www.telecinco.es/informativos/so ... 49107.html

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Commentary

http://www.recombinomics.com/News/11251 ... False.html

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Three children in Iowa recently contracted a new swine flu virus, but scientists don't expect it to spread much further, according to a report from the U.S. Centers for Disease Control and Prevention.

The H3N2 virus identified in the children is genetically related to the H1N1 swine flu virus that caused an atypical pandemic in 2009.

Most animal flu viruses that infect humans don't easily spread from person to person. Flu experts think the close contact of the Iowa children contributed to the spread of the virus.

The children, one girl and two boys who are brothers, had all attended the same event. Their illnesses were described as mild, including fever and respiratory symptoms, and none were hospitalized.

Seven other H3N2 cases reported in the U.S. since July were all in people who had been in contact with pigs. The other illnesses were reported in Pennsylvania, Maine and Indiana.

This year's flu shot has limited protection against this H3N2 virus for adults, but none for children.


Read more: http://www.stltoday.com/lifestyles/heal ... z1ekJkFyAB

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This story has the highest frequency of media myths.

Novel trH3N2 is clearly spreading in humans. Virtually NONE of prior novel cases had CONTACT with swine. Adults have protection due to earlier infections with H3N2, NOT vaccination with current vaccine.

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Commentary

http://www.recombinomics.com/News/11251 ... ution.html

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