Swine influenza: the human animal interface at Minnesota fairs

and live animal markets

Joni Scheftel DVM, MPH, dip ACVPM State Public Health Veterinarian Minnesota Department of Health

joni.scheftel@state.mn.us 651-201-5107

September 16, 2013

History of Swine influenza Infections in Humans in the US

Swine Influenza in People: Previously Rare

•  37 reported cases of swine influenza in humans from 1958-2005, most with swine contact, some with probable person-to-person transmission CID, 2007

•  11 reported cases of triple-reassortant swine influenza A (H1) from 2005-2009, most with swine contact, no known person-to-person transmission NEJM, 2009

Human Infections with SIV in MN •  1996; H1N1; 37 Yr old F; swine contact; fatal •  2008; rH1N1; 29 yr old F; Live animal

market; hospitalized briefly •  2009; rH1N1; 29 yr old F; swine worker •  2010 May; rH3N2; 1 yr old F; Live animal

market •  2010 Dec; rH3N2; 31 yr old M; Live animal

market •  2011; rH1N2; 5 mo-old F; no animal

exposure- sick family member

Swine-Origin Human Influenza Cases by Year and Type, Minnesota, 1996-2012

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U.S.  Cases  of  Variant  Influenza  A  through  2012  

Confirmed Human Cases of H3N2v in the US, 2012 (N = 306)

Date of onset, 2012

Number cases

4138

6

107 11 20

Slide from Dr. Sue Trock

H3N2v at State and County Fairs in the US

and at the MN State Fair during 2012

Slide thanks to Dr. Sue Trock

   States  with  confirmed  cases    11    

   Fairs  associated  with  human  cases  39  

   Confirmed  cases                              309  

   Hospitalized  cases            16  

   Deaths            1  

 

Human  H3N2v  Influenza  Cases    2012,  (n=  305)  

Slide thanks to Dr. Sue Trock

Summary  of  Human  H3N2v  Cases,  2012      •  Median  age  =  6    y.o.    (range  4  mo  –  74  y.o.)  

–  93%  less  than  18  y.o.  •  Most  cases  occurred  in  young  swine  exhibitors  at  county  fairs  with  several  days  exposure  to  pigs  at  a  fair  – 5%  of  cases  were  visitors  to  a  fair  

•  Incuba2on  period  ~  2  –  3  days  •  Dura2on  of  illness  ~  3  –  4  days  

Slide thanks to Dr. Sue Trock

Distribu2on  of  H3N2v  Cases  and  Propor2on  of  Persons  with  H3N2v  HI  An2body  Titer  ≥40  by  Age-­‐Group*  

Slide  from  Lynn  Finelli  

CDC  and  4-­‐H  Recommenda2ons,  2012  

People  at  high  risk  of  serious  complica2ons  from  the  flu  should  avoid  pigs  &  swine  barns  at  the  fair  this  year    High  Risk  groups  include:  <  5  y.o.;  asthma,  diabetes,  lung  or  heart  diseases,  or  other  long-­‐term  health  condi2on;  pregnant  women;  >  65  y.o.          

Slide thanks to Dr. Sue Trock

Very Unpopular Signage

Very, Very Unpopular Signage

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Case Onset Date

human H3N2v human probable H3N2v human H1N2v pig H3N2v pig H1N2v

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

H3N2v and H1N2v Cases in Minnesota, 2012

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Why Not Minnesota County Fairs in 2012 ?

•  The in-office test for influenza doesn’t work for H3N2v

•  MDH Health Alert to HCP’s to submit samples to MDH for special testing of cases of influenza-like illness went out to clinics on August 6, after most county fairs had already occurred

•  Or maybe the virus didn’t start to circulate among show pigs until later in the summer

Surprises and Things We Learned in 2012

•  We were looking for H3N2v in swine exhibitors at the fairs and found it at the Live Animal Markets

•  Instead we found H1N2v in pigs and people at the fair first

•  These were the first human cases of H1N2v with the pandemic M gene in the US

Good things came out of the experience…

•  Great working relationships between BAH, MDA, MDH, State Fair, 4H, U of MN, communications people at all entities

•  Know more about the behavior of swine influenza in people and pigs specifically at fairs and potential for interventions

“Be Healthy at the Fair” Verbiage •  People and animals can share germs •  Wash your hands with soap and water

when you leave the barn •  No food or drink in animal areas •  Remove pacifiers and avoid hand to

mouth contact •  Senior citizens, children under 5,

pregnant women and people with a chronic health condition or a weak immune system should take extra care around animals

Swine Exhibitions Group •  Met January 15 and16, 2013 •  NASAHO and NASPHV Co-leads

– AASV, CDC, IAFE, USDA, 4H, NPB, Ohio State U, U of MN, Swine Registry, NASAHO, and NASPHV

•  Audience: Fair/show organizers and managers, 4H, FFA, Extension personnel, exhibitors and their families, practicing vets, animal health and public health officials

Swine Exhibitions Group

•  Developed “Measures that may be considered to minimize transmission of influenza viruses between swine, between people and swine and between swine and people at swine exhibitions” – Prior to the exhibition – At the exhibition – After the exhibition

2013 Healthy Fairs Workshops

2013: Increased surveillance for novel influenza infections

•  Sent Health Alert to remind HCP’s to send nasal swabs for influenza testing to MDH from people with ILI who report swine contact

•  Set up system for sampling of sick 4H kids at the state fair (same as 2012)

Postcard to 4H Families in the Swine Project

       July  12,  2013    Dear  Swine  Exhibitor  and  Parents:    Just  a  heads  up  that  there  have  been  cases  of  influenza  in  people  showing  swine  or  visiting  the  swine  barn  at  fairs  in  Indiana.  So  far,  no  cases  have  been  identified  in  Minnesota,  but  we  want  to  be  prepared.  As  a  reminder,  if  you  develop  flu-­‐like  symptoms  (cough,  sore  throat,  body  aches,  runny  nose,  or  fever)  within  a  week  of  the  fair  please  talk  to  your  doctor  and  ask  to  have  a  nasal  swab  sent  to  the  Minnesota  Department  of  Health  for  testing.      If  you  have  questions  about  flu  in  pigs,  please  contact  the  Minnesota  Board  of  Animal  Health  at  651-­‐201-­‐6844;  if  you  have  questions  about  the  flu  in  people,  please  contact  the  Minnesota  Department  of  Health  at  651-­‐201-­‐5414.  For  information  on  measures  you  can  take  to  keep  your  pigs  healthy  before,  during,  and  after  the  fair,  please  go  to:  http://usaha.org/.      Sincerely,      Beth  Thompson,  JD,  DVM     Joni  Scheftel,  DVM,  MPH    Senior  Veterinarian       State  Public  Health  Veterinarian  Minnesota  Board  of  Animal  Health   Minnesota  Department  of  Health  

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Cases

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U.S.  Cases  of  Variant  Influenza  A  

Swine-Origin Human Influenza Cases by Source of Infection, Minnesota, 1996-Sept 14 2013

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Live Animal Market

Fair

Swine Farm/Industry

Person-to-Person

Unknown