H3N2 Identified in Indiana Fair Attendees – IDPH alert

The following alert was released by the Illinois Dept of Public Health on July 2nd 2013.

MEMORANDUM

TO: Regional Offices of Illinois Department of Public Health, Local Health Departments, Hospital Emergency Departments, Infection Control Professionals and Infectious Disease Physicians

FROM: Communicable Disease Control Section

DATE: July 2, 2013

SUBJECT: H3N2v Identified in Indiana Fair Attendees (Guidance to Hospitals & Clinicians)

The first human cases of H3N2 variant (H3N2v) during 2013 have been reported by the state of Indiana. All four cases reportedly attended the Grant County Agricultural Fair, June 16-22, prior to illness, and at least two had contact with swine. One of these cases has been confirmed at CDC.

In 2012, 309 cases of H3N2v infection were detected in 12 states. Most of these infections were associated with prolonged exposure to pigs at agricultural fairs. Limited human-to- human spread of this virus has been detected in the past, but no sustained community spread of H3N2v has been identified to date.

Illnesses associated with H3N2v infection in 2012 were mostly mild with symptoms similar to those of seasonal flu. Children are believed to have little to no pre-existing immunity to this virus, while adults may have some pre-existing immunity. More severe illness can happen in persons with high risk conditions such as asthma, diabetes, heart disease, neurological or neurodevelopmental conditions and pregnancy. Also, those younger than five years or older than 65 years are also at higher risk.

Testing for influenza using RT-PCR at the IDPH Division of Laboratories is recommended for:

  1. Hospitalized patients with fever and cough or sore throat
  2. Patients with fever and cough or sore throat with either of the following
    1. Direct contact (raising pigs, feeding pigs, cleaning pig waste) or indirect exposure to pigs – visiting a pig farm, walking through a swine barn at a county fair, etc.), especially if pigs were known to be ill; or
    2. Close contact (within 2 meters or approximately 6 feet) to an ill person who had recent swine exposure.

* Note: Negative rapid tests do not rule out H3N2v

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Clusters of influenza-like-illnesses should also be reported to the local health department for consultation regarding testing. Requests for testing will also be considered on a case by case basis in unique circumstances. Please refer to the links below for specimen submission guidelines and the Influenza disease specimen submission form. http://www.idph.state.il.us/flu/Influenza_Virus_Specimen_Submission.pdf http://www.idph.state.il.us/about/laboratories/Flu-Respiratory_Req_Form.pdf

Clinicians evaluating ill patients suspected to be cases of probable H3N2v virus infection in persons with recent exposure to swine or to an ill person who had swine exposure should obtain a nasopharyngeal swab or aspirate (or a combined nasal swab and throat swab) from the patient, place the swab or aspirate in viral transport medium, and contact their local or state public health department to arrange transport and testing for H3N2v virus at a state public health laboratory.

Respiratory specimens for H3N2v testing should ideally be obtained during the first three days after symptom onset, but may be taken up to a week after onset, or even later in children, severely ill, or immunocompromised patients. If specimen collection kits are needed, please contact your appropriate regional IDPH laboratory.

Prior to sending specimens, approval for testing must be obtained by contacting your local health department. The local health department will provide an authorization code that must be printed on the submission form.

If you have questions about specimen submission, collection or transportation please call your appropriate regional laboratory (Chicago: 312-793-4760; Springfield: 217-782-6562; Carbondale: 618-457-5131). If questions arise after hours, please first contact your local health department using their afterhours number. If they are not available, please contact IEMA at 800-782-7860 and request to speak with the IDPH duty officer.

Additional information about H3N2v, including CDC recommendations for treatment of suspect or confirmed H3N2v infection is available at http://www.cdc.gov/flu/swineflu/h3n2v- cases.htm