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New Swine Flu Virus Found in Ohio and Michigan

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    Posted: November 11 2016 at 7:24am
Cases of New Swine Flu Virus Found in Ohio and Michigan

NOV 10, 2016 | EINAV KEET

Local agricultural fairs offer a family-friendly outing to celebrate regional farmers, but exposure to farm animals at these fairs can also create an avenue leading to illness. The Centers for Disease Control and Prevention (CDC) recently identified a new type of swine flu in people in two states, which they’ve linked back to state fair attendance.

The CDC’s Morbidity and Mortality Weekly Report (MMWR) offers a weekly roundup of news on public health from the agency. Their report for the week of October 28th details findings from their investigation of 18 swine flu cases contracted in July and August, which were first reported to the CDC by the Ohio Department of Health Laboratory and the Michigan Department of Health and Human Services Laboratory. A respiratory specimen from a 13-year-old boy in Ohio taken in late July was tested using real-time reverse transcription–polymerase chain reaction (RT-PCR) and came up positive for an influenza A (H3N2) variant, a swine flu that typically infects swine populations and occasionally causes illness in humans. Soon after, Michigan health officials reported finding the same H3N2 variant in a 9-year-old child. Both cases were linked to visits to local agricultural fairs, where the children came into contact with pig exhibits believed to have transmitted the swine flu. By August 25th, health officials identified and reported a total of 18 cases resulting from two H3N2 variant viruses. Of those infected, 13 people had come in direct contact with pigs through touching or handling, while five had only indirect contact such as passing through a barn. Of those who fell ill, 16 were children, seven of whom were under the age of 5. One person was hospitalized, and all had full recoveries.

Symptoms of swine flu are similar to the human seasonal flu, including fever, coughing, and sore throat. The largest known outbreak of an H3N2 variant virus occurred in 2012, though there were only 343 reported cases from 2011 to 2014. Swine flu does not typically infect humans, but the virus is more likely to spread from human-to-human when it undergoes genetic reassortment, which consists of combining genes of viruses from different species. In the recent 18 cases reported in Ohio and Michigan, the CDC identified 16 reassortments of swine and human viruses in a combination of genes that had not been previously found in H3N2 variants infecting humans. The report notes that the hemagglutinin gene found in the swine flu virus is a human gene likely introduced to swine in 2010 or 2011, and that this new reassortment has likely been circulating and evolving in pig populations since then, making the recently discovered virus genetically and antigenically different from the H3N2 virus currently circulating and causing seasonal illness.

“Influenza viruses are constantly evolving and are unpredictable so we cannot say with certainty that we will detect this same virus in humans again,” said Rebekah Stewart Schicker, MSN, MPH, Epidemic Intelligence Service Officer at the CDC, noting that variant viruses can also come from swine that people keep on their property. “However, our previous experience tells us that new variant viruses usually circulate for more than one year so it is likely that we will see this virus emerge again in the following years.” Schicker noted that the CDC continually tracks influenza activity through surveillance with public health and clinical laboratories, outpatient healthcare providers, hospitals, state health departments, and other agencies.

The recent cases underscore the importance of taking precautionary measures around swine and their environments to prevent such influenza outbreaks. The new MMWR report emphasizes that agricultural fair organizers should take preventive steps to protect the public, including limiting the time that swine are on the fairgrounds, keeping ill swine isolated, having an on-call veterinarian, offering handwashing stations, and prohibiting food and beverages in animal barns. For people who may come in contact with swine, the CDC recommends the following safety measures:

For People with High Risk Factors: •Anyone who is at high risk of serious flu complications planning to attend a setting where pigs will be present should avoid pigs and swine barns.
•People who are at high risk of serious flu complications include children younger than 5 years, people 65 years and older, pregnant women, and people with certain long-term health conditions (such as asthma and other lung disease, diabetes, heart disease, weakened immune systems, and neurological or neurodevelopmental conditions).
For People Not at High Risk: •Don’t take food or drink into pig areas; don’t eat, drink or put anything in your mouth in pig areas.
•Don’t take toys, pacifiers, cups, baby bottles, strollers, or similar items into pig areas.
•Avoid close contact with pigs that look or act ill.
•Take protective measures if you must come in contact with pigs that are known or suspected to be sick; this includes minimizing contact with pigs and wearing personal protective equipment like protective clothing, gloves, and masks that cover your mouth and nose when contact is required.
•Wash your hands often with soap and running water before and after exposure to pigs. If soap and water are not available, use an alcohol-based hand rub.
•To further reduce the risk of infection, minimize contact with pigs in the pig barn and arenas.
•Watch your pig (if you have one) for illness. Call a veterinarian if illness is suspected.
•Avoid contact with pigs if you have flu symptoms. Wait to have contact with pigs until 7 days after your illness started or until you have been without fever for 24 hours without the use of fever-reducing medications, whichever is longer. If you must have contact with pigs while you are sick, take the protective actions listed above.
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Alarming surge of swine flu in Nepal

Aug 13, 2017-

The flow of patients with influenza-like-illness (ILI) has been increasing throughout the country. Dozens of patients are visiting the Sukraraj Tropical and Infectious Disease Hospital in Teku each day for the treatment of such flu like cases. Most of them exhibit symptoms of high fever, dry cough, weakness, chills, sore throat, runny nose, fatigue, diarrhoea in children, and headache; these symptoms are associated with the swine flu virus. The H1N1 influenza A (pdm09) virus, known more commonly as the swine flu virus, was first detected in people of Mexico in April 2009.

The virus has claimed the lives of 12 people and has been confirmed in over 100 patients around Nepal over the past two weeks. With more people being diagnosed with swine flu and the death toll rising, people are worried about the spread of the virus and its consequences. Similar cases have been reported in Myanmar and some states of India. The recent outbreak is worrying because it seems to be the same strain of swine flu that caused a pandemic in 2009, and a major outbreak in Jarjarkot in 2015. Scientists have claimed to have found at least two new strains very similar to the pdm09; these three strains are wreaking havoc all around the world.

Most of the patients diagnosed with swine flu have died because of pneumonia. TU Teaching Hospital (TUTH) organised a vaccination program for all their staff recently and used a new vaccine called the Influvac 2017. This particular vaccine has been recommended by World Health Organisation (WHO) and has proven effective against flus in 2017. Influenza viruses are the major determinant of morbidity and mortality caused by respiratory diseases. Influenza has been responsible for millions of deaths worldwide and causes annual outbreaks of variable intensity. The frequency at which the influenza virus mutates and creates new strains means that it is always a challenge to stay a step ahead and battle the flu. Influenza type A is highly variable and is responsible for most of the epidemic cases; type B may exhibit genetic changes and sometimes cause epidemics; type C is stable and causes mild illness in individuals with an immunity deficiency.

According to the Epidemiology and Disease Control Division (EDCD), this year, there have been more cases of influenza in comparison to last year. For the past month, seasonal flu has been spreading rapidly and it’s becoming difficult to treat all patients in time. EDCD has warned that the “as being a highly communicable viral disease, the flu may spread heavily throughout the country and there is no care except sanitation and awareness”. The timing of this viral disease is very unpredictable and can vary in different parts of Nepal and from season to season. The number of cases of ILI increased drastically in the past weeks.

Transmission and pathogenesis

The influenza virus mainly attacks the upper respiratory tract. It poses a serious risk for the elderly, the very young, and people with underlying medical conditions such as kidney, lung, or heart problems, cancer, or diabetes. Influenza virus spreads from person to person by airborne droplets or by contact with contaminated surfaces or hands. The incubation period from exposure to the virus to the onset of illness varies from one to four days; it depends on the size of the viral dose and the immune status of the host. The virus multiplies within eight to 10 days and spreads to adjacent cells, where the replicative cycle is repeated. Infection causes cellular destruction and peels off the upper membrane protecting the lung cells. Within a short time, many cells in the respiratory tract are infected and killed. Symptoms of classic influenza normally appear abruptly and include headache, chills and cough, followed closely by high fever, malaise, muscular aches and anorexia. Fever induced seizures can occur in children, along with the swelling up of air passages. The mortality of an influenza epidemic is reflected in the excess deaths due to pneumonia and other heart and lung diseases. Flu infection enhances susceptibility of patients to bacterial infection. Combined viral-bacterial pneumonia is three times more dangerous than viral pneumonia.

Diagnosis and prevention

The only place for diagnosing influenza in Nepal is the influenza centre at the Nepal Public Health Laboratory, Teku. In the absence of required rapid diagnostic kits and equipment, this virus is often misdiagnosed as the regular flu. Specimens for diagnosis are taken through nasal washings, gargles, and throat swabs. Samples should be collected within the first three days after the onset of symptoms. Reverse-transcription polymerase chain reaction (RT-PCR) helps in the direct detection of viral RNA or specific viral antigens in collected specimens. However, this is not currently available in all clinical facilities in Nepal.

There is no specific drug against this viral infection to date. Only the symptoms can be managed to ease the patient. Patients should drink plenty of liquids, and should get bed rest. If complications develop, a doctor should be referred to immediately. For secondary bacterial infections, physician should prescribe the Azithromycin antibiotic for a regular five day course. The government should conduct awareness programmes and provide medical experts throughout the country with ample diagnostic kits. The Ministry of Health should additionally launch seasonal flu vaccination programmes on time, at least for vulnerable groups. Health authorities should run screening protocols. Washing hands with soap and water, or the use of alcohol based hand sanitizers is highly effective in reducing the chance of infection. Individuals should stay away from the crowded areas, and should wear facemasks while outdoors.
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