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The Centers for Disease Control and Prevention is asking health care providers to be on special look out for swine flu.



That's because, since August, 12 people have come down with a specific sub-type of the disease.

It's known as the H3N2 virus. So far it has turned up in Indiana, Iowa, Maine, Pennsylvania and West Virginia.

Eleven of those infected were children. Three patients were hospitalized. But all have fully recovered.

The swine flu became a global pandemic beginning in 2009. An estimated 43 to 89 million caught swine flu, and up to 18,000 died from it, according to the CDC.

The World Health Organization officially declared an end to the pandemic last year.

This year's flu vaccine is good against the H3N2 variant.

The CDC recommends that everyone six months and older get a flu shot.

http://abclocal.go.com/wls/story?sectio ... id=8481292

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The government has enhanced its monitoring mechanism in the wake of news that U.S. and Hong Kong authorities confirmed the presence of the swine-origin H3N2 virus and the H5N1 avian influenza virus in a child and dead chicken, respectively, a health official said Tuesday.

According to reports, the two viruses did not spread outside the countries and the Centers for Disease Control (CDC) is taking precautionary measures out of concern for the public's safety, said Chuang Jen-hsiang, director of the CDC.

U.S. public health officials recently became aware of a case of H3N2 human infection in a child from the state of West Virginia, Chuang said.

Meanwhile, Hong Kong's secretary for food and health announced a week ago that a dead chicken found in a wholesale poultry market had tested positive for the H5N1 virus.

The trading of live poultry in Hong Kong was immediately suspended for 21 days, and all 17,000 chickens at the wholesale market were culled. (By Chen Ching-fang and Hanna Liu) ENDITEM/npw

http://focustaiwan.tw/ShowNews/WebNews_ ... 1112270043

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The reach of the new swine influenza wave has extended to new geographic boundaries as the virus spread to West Virginia and Minnesota last week. According to the Canadian Press, the U.S. Centers for Disease Control reported that the cases involved strains of the H3N2 virus along with the H1N2. Both cases affected children under the age of five years old who have not been in contact with swine.

“It does make us take it pretty seriously,” said CDC influenza division representative Lyn Finelli, noting that the virus has now been confirmed in Maine, Pennsylvania, Iowa, West Virginia and Minnesota.

The CDC believes the viruses are being transmitted to other people at low levels, with even those who have had their seasonal flu shot at risk for infection. The virus is genetically different enough that traditional flu protection offers no advantages; however, it is believed that most people over the age of 20 have already developed some sort of immunity to the virus.

In fact, all but one of the 11 cases of swine influenza identified so far were in children under the age of 10, the Canadian Press said. The one exception was a 58-year-old person. Only three people have been hospitalized thus far, with other health problems the primary cause for complications.

The H3N2 strain of the virus was first spotted in July in people who had had contact with swine. It is a close cousin of the H1N1 virus that caused panic in 2009, sharing the M gene that makes the flu more transmissible.

http://www.thirdage.com/news/swine-infl ... 12-27-2011

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Health officials watching for new version of swine flu
Dec 27, 2011

BY MARTIN ESPINOZA / THE PRESS DEMOCRAT

Local public health officials are on the lookout for a new swine-related flu virus, though it does not appear to be as dangerous as the swine flu virus of 2009.

Mark Netherda, interim Sonoma County public health officer, said only 12 cases of the new flu have been identified nationally since summer and that in half of those cases those infected had direct or indirect contact with pigs.

Three of those cases required hospitalization, though those patients had underlying chronic medical conditions. All 12 patients that have tested positive for the new H3N2v virus have recovered.

“Right now there’s no reason to think that H3N2v is a particularly bad or virulent flu,” Netherda said. “We’re just trying to collect more information to determine if it’s widespread and how easily it’s transmitted.”

The virus has been reported in Pennsylvania, Maine, Indiana, Iowa and West Virginia. Eleven of the 12 patients were children. There were no cases in California.

The virus acquired a gene segment from the 2009 pandemic swine flu, which is now commonly spreading in both humans and pigs, according to the federal Centers for Disease Control and Prevention.

With direction from the CDC, the state has asked local public health departments to increase surveillance testing for influenza, including subtyping, from patients with flu-like symptoms, particularly those under 18, Netherda said. Among other things, federal epidemiologists are trying to gather information about the transmission potential of the new virus.

Local medical professionals are being asked to:

1. Be alert to flu-like infections, especially in children under 18 years of age.

2. Test flu-like illness cases in patients under 18, and send naso-pharyngeal swab specimens to Sonoma County Public Health Lab.

The county health department said the surveillance testing is offered at no charge to patients and that specimens will be tested in batches with results reported weekly.

The year’s flu season, which began in early October, has gotten off to a slow start, he said. And although there is very little flu being reported, public health officials stress the importance of flu prevention measures, such as flu vaccination, frequent hand washing and covering coughs.

The county also asks that health care providers be prepared to screen patients for signs and symptoms of febrile respiratory illness as they enter medical facilities.

But Netherda stressed that there is no cause for alarm. The 12 cases reported since July is in stark contrast to the spread of H1N1. It was first discovered in mid-April 2009, near the beginning of the Southern Hemisphere flu season. Just two weeks later, swine flu had reached Sonoma County.

“Right now this is looking like it’s benign,” he said. “It’s just not taking off the way H1N1 did.”

http://m.pressdemocrat.com/article/2011 ... how=single

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http://www.cidrap.umn.edu/cidrap/conten ... dance.html

Novel flu cases prompt new CDC guidance
Lisa Schnirring Staff Writer


Dec 28, 2011 (CIDRAP News) – Alongside last week's confirmation of another novel flu infection with an H3N2 variant, the US Centers for Disease Control and Prevention (CDC) launched a series of documents to advise health and lab workers on how to identify and report new cases.

On Dec 23 the CDC confirmed two more novel flu infections, including in a West Virginia child with a swine-origin H3N2 reassortant strain (H3N2v) that includes the M gene from the 2009 H1N1 virus. The youngster was a daycare contact of an H3N2v case reported on Dec 9, and the newly confirmed case pushed the nation's H3N2v total to 12 so far.

The other novel flu infection involved a swine-origin H1N1 variant (H1N1v) that had also acquired the M gene from the 2009 H1N1 virus. The CDC said the patient, an adult from Wisconsin who had occupational exposure to swine, was the first detection of the H1N1v strain in a human.

On the same day the CDC announced the two novel flu cases, it released documents that address preventing seasonal and H3N2v in healthcare settings, interim guidance on H3N2v specimen collection and testing, and interim case definitions for investigating H3N2v infections.

Most H3N2v infections have been mild, and only 3 of the 12 patients were hospitalized, the CDC said. Though it's not clear if cases will become more common, it's possible that healthcare providers will care for patients who have H3N2v infections, it added.

So far there is no evidence that H3N2v transmission characteristics are different from seasonal flu, so the CDC advises that facilities use the same infection control procedures as for seasonal flu to help guard against the spread of H3N2v, including the vaccination of healthcare workers. However, it added that the seasonal flu vaccine may provide limited protection against H3N2v in adults and no protection in children.

Given that limited person-to-person spread of H3N2v seems to be occurring, especially in children, the CDC released interim guidance designed to streamline its detection and investigation. It advised state and local health departments to use the CDC's real-time reverse transcriptase polymerase chain reaction (rRT-PCR) panel to screen for influenza A, influenza B, and ribonuclease P (an indicator of specimen adequacy), then use its influenza A subtyping kit, employing all primer and probe sets.

The CDC recommended that states increase the collection of respiratory specimens from patients with flulike illnesses who fall into certain high-priority groups, including children in childcare and school settings, unusual or severe flulike illness presentations (especially in kids), and medically attended flulike illnesses and acute respiratory infections in children.

Interim recommendations for collecting respiratory specimens for patients with suspected H3N2v infections are consistent with those for seasonal flu, the CDC said. It added that the duration of H3N2v shedding is unknown, and until more data are available, infected patients should be assumed to be contagious for up to 7 days from illness onset.

It said molecular assays may detect novel influenza A viruses but will not differentiate them from seasonal strains and may give an unsubtypable result, which should be forwarded to state or local labs for additional testing. Molecular assays may give a false-positive result for human H3 viruses, according to the CDC.

Rapid and immunofluorecense tests have unknown sensitivity and specificity to the H3N2v virus, and negative results from either test don't rule out flu infections in patients with signs and symptoms that suggest influenza.

The CDC said H3N2v viruses will be positive for the nucleoprotein (NP) gene (pdmInfA), influenza A, and seasonal influenza A (H3) targets of the CDC's rRT-PCR diagnostic panel. All suspected novel influenza A and H3N2v samples should be sent to the CDC for confirmational testing, it said. "Confirmation of influenza A (H3N2)v virus is performed only at CDC at this time."

The agency urged health departments to conduct contact tracing of confirmed, probable, or suspected H3N2v cases and provided definitions for the three levels of cases in a separate document. It asked health departments to notify the CDC about all suspected and probable H3N2v infections within 24 hours of identification.

The CDC defined a suspected H3N2v case as an acute respiratory illness in a patient who has an epidemiologic link to a confirmed case or got sick within 7 days of swine exposure.

It said a probable case is in a patient whose respiratory sample tested positive on the CDC RT-PCR flu panel for influenza A, pandemic influenza A, and H3, but negative for influenza B, pandemic H1, and H1. Also, a probable case could be in a person who has an acute respiratory infection and a link to a confirmed H3N2v case and whose diagnostic test is positive for influenza A (H3) or influenza A (no subtype tested or detected).

In a related development, the CDC updated its background information on swine influenza for pork producers and farmers, incorporating the latest information about novel influenza A viruses, urging people to take precautions when pigs and animal handlers have respiratory illnesses.

See also:

Dec 23 CDC prevention strategies for seasonal and H3N2v influenza in healthcare settings

Dec 23 CDC interim guidance for H3N2v specimen collection

Dec 23 CDC interim guidance for testing patients who have a suspected H3N2v infection

Dec 23 CDC interim guidance on H3N2v case definitions

Dec 23 CDC information for pork producers and farmers

Dec 23 CIDRAP News story "CDC reports two more novel flu infections"

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In addition to the early release MMWR, late on Friday, the CDC also did a 50 state conference call to get the word out.

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Commentary

http://www.recombinomics.com/News/12291 ... ck_US.html

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The Centers for Disease Control and Prevention (CDC) has recently released a report, “Update: Influenza A (H3N2)v Transmission and Guidelines — Five States, 2011” with updated information on new nomenclature for influenza A (H3N2) viruses in swine and case reports of human illness. The report also provides an overview of the U.S. Department of Agriculture’s swine influenza virus (SIV) surveillance program along with data on influenza A (H3N2)v viruses in swine.

Veterinarians (and their producers) should take note of this because one of the cases of human illness involved a person with daily contact with swine (other cases did not involve swine contact). An editorial note in the December 23rd Morbidity and Mortality Weekly Report (MMWR) says that work exposure highlights the risk for interspecies influenza transmission in occupational settings where humans are exposed to swine.

Swine workers are encouraged to 1) get vaccinated against human seasonal influenza, 2) wear appropriate persona protective equipment, and 3) practice good hygiene, such as washing hands thoroughly with soap and water, when in contact with swine, especially swine that show signs of illness. These same recommendations can be made for veterinarians who may come in contact with swine operations.

Persons with swine exposure in the week before onset of an illness with symptoms of influenza requiring medical care should notify their health-care provider of their swine exposures. Persons who develop symptoms of influenza after close contact with swine are recommended to stay home until well to minimize contact with persons and swine as much as possible.

The MMWR indicates that these viruses carry a newly identified combination of genes, and little information is available regarding transmission efficiency in swine, in humans, or between swine and humans. However, the recent human cases involving swine exposure and results of SIV surveillance indicate that these viruses also currently are circulating in swine herds.

Read the full report here.

http://www.cattlenetwork.com/bovine-vet ... 17333.html

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December 28, 2011 — The number of reported cases of a novel swine influenza virus has risen to 12 since July, encompassing 5 states, according to the US Centers for Disease Control and Prevention (CDC). The virus includes a gene from the human pandemic strain and affects mostly children.

The agency is taking the influenza newcomer seriously, urging public health departments, hospitals, and clinicians engaged in influenza surveillance to consider the possibility of the virus in patients presenting with influenza-like illness (ILI).

The infections in question involve a variant of the A(H3N2) virus that circulates among pigs. It contains a gene from the pandemic 2009 influenza A(H1N1) virus that codes for matrix proteins found in the viral shell.

The novel virus is worrisome enough that the CDC, the World Health Organization, and the World Organisation for Animal Health have dubbed it A(H3N2)v. The "v," which stands for "variant," distinguishes the novel virus from the seasonal A(H3N2) virus. The 2011-2012 seasonal influenza vaccine is designed to protect against this strain, the 2009 pandemic strain, and an influenza B strain.

In 3 of the 5 states where the A(H3N2)v virus has surfaced — Indiana, Pennsylvania, and Maine — patients became infected after direct or indirect contact with pigs. In Iowa and West Virginia, the other 2 states, the evidence suggests that the virus spread from human to human on a limited basis.

The CDC has not found evidence of sustained human-to-human transmission of the virus, but "all influenza viruses have the capacity to change, and it's possible this virus may become widespread," the agency states on its Web site.

One seeming bit of good news is that, so far, the A(H3N2)v virus causes illnesses that are generally no worse than those triggered by the seasonal influenza virus. Three of the 12 patients were hospitalized, but they and all the others recovered.

However, there is a bad-news chaser: The seasonal influenza vaccine for 2011-2012 is unlikely to protect people from the A(H3N2)v virus, the CDC reports. In addition, limited serologic studies indicate that young children have little preexisting immunity, although older children and adults may have limited immunity.

New Flu Question: "Have You Been Around Pigs?"

The CDC reported the first 2 cases of the A(H3N2)v influenza — both involving children under 5 years of age — on September 2 in its Morbidity and Mortality Weekly Report (MMWR). In 1 case, a girl in Pennsylvania came down with the infection after exposure to pigs at an agricultural fair on August 16. Direct exposure to pigs was not a factor in the other case, involving a boy in Indiana, but his caretaker had come into direct contact with asymptomatic pigs before the onset of the boy's illness in July.

The first likely instance of limited human-to-human transmission of the A(H3N2)v virus was described in an MMWR report published December 2. The virus was discovered in 3 children in 2 counties in Iowa who had been in contact with each other (2 were brothers). None of them had had any recent exposure to pigs.

On December 23, the CDC published another MMWR report that brought the infection count up to 12 and described the 3 latest cases: another in Indiana and 2 cases in West Virginia. In Indiana, a man who had worked with pigs was hospitalized for 4 days in October. In contrast, 2 children under 5 years of age in West Virginia were infected with the A(H3N2)v virus without having come into contact with pigs or traveling recently. Both attended the same daycare center.

The authors of the MMWR report write that it is unlikely that the first child to be infected transmitted the virus to the second one, given a gap of more than 10 days between their onset of symptoms. Nevertheless, the authors attribute those 2 cases to "apparent limited human-to-human transmission" of the virus, which conceivably could have spread from others at the daycare center.

These different epidemiologic scenarios figure into CDC advice to clinicians and public health agencies about the A(H3N2)v virus. Clinicians should consider the possibility of the novel virus when patients presenting with febrile respiratory illness have recently been near pigs. They also should keep A(H3N2) as a diagnostic option even when there has been no human–pig encounter, particularly for young children in states where A(H3N2)v infections have been reported. If they suspect an A(H3N2)v infection, they should obtain a nasopharyngeal swab, place it in a viral transport medium, and contact their local or state health department to have it tested.

Likewise, the CDC recommends that state and local health departments should consider collecting more specimens from patients presenting with ILI in 3 high-priority areas:

•ILI outbreaks, especially among children in school and childcare settings;
•Unusual or severe presentations of ILI, especially among children; and
•Medically attended ILI and acute respiratory illness in children under 18 years of age.
A Second Novel Influenza Virus Is on the CDC's Radar

In addition to the A(H3N2)v virus, another novel version of swine influenza is on the CDC's radar. In a recent post on its Web site, the agency reported the discovery of an A(H1N1) virus with genes from avian, swine, and human influenza genes. Like A(H3N2)v, it features the matrix gene from the pandemic 2009 influenza A(H1N1) virus, which probably was transmitted from humans to swine after the outbreak of the 2009-2010 pandemic. The novel virus, called A(H1N1)v, was detected in a Wisconsin man who had worked with pigs before getting sick. The CDC did not identify any human-to-human transmission of this virus.

As with A(H3N2)v, the current formulation of seasonal flu vaccine probably will not protect people from A(H1N1)v. Laboratory tests show that A(H1N1)v is susceptible to the antiviral medications oseltamivir (Tamiflu, Roche) and zanamivir (Relenza, GlaxoSmithKline). Those 2 medications also should prove effective against A(H3N2)v, according to the CDC.

More information on the A(H1N1)v virus is available at the CDC Web site.

http://www.medscape.com/viewarticle/756148

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Standardization of terminology for the variant
A(H3N2) virus recently infecting humans
Joint announcement of FAO, OIE and WHO
23 December 2011

FAO, OIE and WHO continue working closely together to address influenza issues related to public health and animal health.

Since July 2011, twelve human cases of infection with a variant influenza A(H3N2) virus have been detected in the United States. To date, no report has been received from elsewhere in the world. This virus has different virological characteristics from current circulating seasonal influenza viruses in humans, and has a new gene constellation: 7 genes from the triple reassortant A(H3N2) viruses known to have been circulating in pigs in the North America and the M gene from an A(H1N1)pdm09 virus, a seasonal virus currently circulating in humans.

In order to improve communications and avoid confusion, FAO, OIE and WHO have established a working group of experts to standardize the terminology for variant influenza viruses. The joint recommendation for the above mentioned A(H3N2) virus is: A(H3N2)v , where “v” stands for “variant”.

An example of use of the terminology:

Sporadic human cases of infection with a variant influenza A(H3N2) virus A(H3N2)v have been reported in the USA. The A(H3N2)v virus is different from seasonal viruses currently circulating in humans.
For more information, please contact FAO at GLEWS@fao.org, OIE at scientific.dept@oie.int and WHO at gisrs-whohq@who.int.

http://www.who.int/influenza/gisrs_labo ... index.html

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