Reports from 3 states suggest more variant H3N2 cases

Aug 1, 2012 (CIDRAP News) – Reports from three states today suggested an increase in swine-origin H3N2 influenza activity, with one human case confirmed in Hawaii and suspected human cases cited in connection with county fairs in Ohio and Indiana.

The Hawaii Department of Health (DOH) announced yesterday that a case of variant H3N2 (H2N2v) was confirmed in a Maui resident who had possible exposure to pigs.

In Ohio, state officials said preliminary test results pointed to possible H3N2v in 10 people who had contact with swine at the Butler County Fair, north of Cincinnati. Officials were awaiting further test results from the Centers for Disease Control and Prevention (CDC).

And in Indiana—where four cases of H3N2v were reported last week—both people and pigs were being tested in the wake of sickness among pigs in the swine barn at the Monroe County Fair in Bloomington, according to state officials and media reports.

The new reports come a week after the four H3N2v cases were confirmed in people who had shown pigs at the LaPorte County Fair in northwestern Indiana. Those cases raised the number of known H3N2v cases in the United States to 17 in the past year.

Surveillance flagged Hawaiian case
The Hawaiian patient sought medical attention after experiencing typical flu symptoms, the DOH said. The patient's doctor, a member of the state's flu surveillance network, sent a sample to the state laboratory for testing, and the CDC confirmed the case late last week. The patient recovered fully without hospitalization, officials said.

Noting that most of the other H3N2v cases in the past year have occurred in children and in those who work with pigs, the DOH statement said, "In this case, preliminary DOH findings suggest the latter exposure, although the investigation is ongoing in collaboration with HDOA [the Hawaii Department of Agriculture]."

"HDOA veterinarians will be taking samples to investigate the status of swine herds potentially associated with this case," State Veterinarian James Foppoli, DVM, said in the release.

Hawaii State Epidemiologist Sarah Park, MD, commented in the release, "The virus seems to be behaving as previously observed in other cases, with illness similar to seasonal flu and with no sustained community transmission."

Ohio investigation
In Ohio, the investigation of possible human cases related to the Butler County Fair was announced by state officials and the Butler County Health Department. "Preliminary laboratory results on ten samples indicate similarities to the influenza virus, (H3N2)v," the announcement said. "All individuals in Butler County's investigation had direct contact with swine," but the CDC has not yet confirmed any of the cases, the agency said.

Tessie Pollock, a spokeswoman for the Ohio Department of Health, told CIDRAP News, "No one was hospitalized. Most of them recovered on their own; a couple of them needed antivirals. We're not seeing anything more severe than with cases of seasonal flu."

She declined to give information about the patients' ages.

Ohio State Veterinarian Tony Forshey, DVM, told CIDRAP News that very few pigs were sick at the fair, but random swine testing with polymerase chain reaction pointed to influenza A in some cases. The testing was done by an Ohio State University student as part of a PhD research project.

Forshey commented that the findings were "just coincidental" with the human flu-like illness cases.

He said confirmatory tests are now being done, with results expected by Friday (Aug 3). "We think it'll end up being H3N2, but we don't have that yet," he said.

Cases close county fair swine barn
In Indiana, the swine barn at the Monroe County Fair was closed yesterday because some pigs were sick, and several people who were in contact with pigs at the fair have flu-like symptoms and are being tested, according to media reports that cited state and county officials.

Ken Severson, a spokesman for the Indiana State Department of Health, said today the department is looking into the possible human cases.

Amy Thompson of the Purdue Cooperative Extension Service in Monroe County said that some children got sick after visiting the fair, "but at this point, those illnesses cannot be tied to the hog issue," according to a report from Fox59 news in Indianapolis.

Denise Derrer, spokeswoman for the Indiana State Board of Animal Health, told CIDRAP News that samples have been taken from a dozen pigs at the fair for testing at Purdue University. She said some pigs had clinical signs consistent with flu, but she wasn't sure if all the tested pigs were sick.

She said there is concern about the risk of swine flu at the Indiana State Fair in Indianapolis, which starts Friday. All the pigs brought to the fair will get temperature checks before they are unloaded from trucks, and any with a temperature of 105°F or higher will be sent home, she said.

"We want to make sure everyone has a good experience at the fair," Derrer said.

See also:

Jul 31 Hawaii press release

Aug 1 Ohio press release

Jul 25 CIDRAP News story on LaPorte County, Ind., cases

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