Swine Influenza Incident and Lessons Learned at 2017 Maryland Fairs and Shows

Transcription

1 Mid-Atlantic Zoonotic and Vector (MAZV) Meeting Annapolis, Maryland December 20, 2017 Swine Influenza Incident and Lessons Learned at 2017 Maryland Fairs and Shows PROPOSED CHANGES for 2018 MARYLAND FAIRS and SHOWS Maryland Department of Agriculture Animal Health Program and Maryland Department of Health

2 OUTLINE BASIC INFLUENZA AND SWINE INFLUENZA REVIEW SWINE INFLUENZA AT 2017 MARYLAND FAIRS AND SHOWS 2017 MARYLAND VARIANT INFLUENZA OUTBREAK INVESTIGATION NATIONAL SWINE INFLUENZA RESEARCH DATA LESSONS LEARNED MDA RECOMMENDATIONS FOR THE 2018 MARYLAND FAIR AND SHOW SEASON REFERENCES DISCUSSION

3 INFLUENZA VIRUS 101 RNA virus Three types: A, B, C Influenza A Virus(IAV) type Seasonal and pandemic flu Can infect humans, birds, swine, other species 198 possible subtypes Hemagglutinin: H1-H18 Neuraminidase: N1-N11 Natural reservoirs are wild birds

4

5 SWINE INFLUENZA 101 Classic subtypes H1N1 N3N2 H1N2 Spread Nasal secretions Short distance aerosols Transmission Pig to pig Pig to human Human to pig Commercial pigs are both sub-clinical and clinical cyclic carriers

6 SWINE INFLUENZA PATHOGENESIS Exposure Peak Fever Peak Excretion Prime Sample Collection Viral Clearance Seroconversion Very Short incubation Period! 24 h 48 h 6 8 days days Sub-clinical or clinical signs timeline ~ 2 weeks) Slide compliments of Dr. Marie Gramer U of MN

7 SWINE INFLUENZA AT 2017 MARYLAND FAIRS AND SHOWS

8 2017 Swine Influenza at Maryland Fairs and Shows TIMELINE Sunday, September 17: sick pigs reported at the Charles County Fair 34 swine exhibitors (26-4H and 8-open), 107 pigs on the fairgrounds 4 exhibitors pigs, 5 clinical pigs are swabbed A Hold Order is placed, terminal pigs are allowed to go directly to slaughter Leaving 60 pigs under strict biocontainment/ biosecurity protocols

9 TIMELINE (CONTINUED) Monday, September 18: Salisbury Animal Health Laboratory (SAHL) reports the 5 clinical pigs are positive for Influenza A Virus (IAV) 5 samples sent to the National Veterinary Service Laboratories(NVSL) for confirmation and serotyping 9-4H children are reported with ILI clinical signs The Maryland Department of Health (MDH) is notified Secretary Bartenfelder signs an Emergency Order closing the St. Mary s County and Calvert County Fairs to swine

10 TIMELINE (CONTINUED) Tuesday, September 19: NVSL reports all 5 samples are H3N2 Wednesday, September 20: MDH reports that 7-4H children are positive for H3N2v. The Frederick County Fair is notified 131-4H swine exhibitors, 294 pigs on the fairgrounds 91-4H breeder pigs are immediately sent home Leaving 203 pigs still on the fairgrounds

11 TIMELINE (CONTINUED) Thursday, September 21, 2017: MDH reports a young child is hospitalized with ILI clinical signs after exposure at the Frederick County Fair The Frederick County Fair swine barns are closed to the public Friday, September 22: 17 exhibitors, 55 open swine are shown and discharged all in one day

12 TIMELINE (CONTINUED) Saturday, September 23: sick pigs reported at the Frederick County Fair 114-4H market swine exhibitors, 203 pigs on fairgrounds 7-4H swine exhibitors, 11 clinical, 1 dead pig An oral Hold Order is placed, if cleared the market swine are allowed to go directly to slaughter Sunday, September 24: SAHL reports all 11 samples are positive for IAV

13 TIMELINE (CONTINUED) Monday, September 25: 3-4H Frederick County breeder pigs exhibitors discharged on 9/20/17 report sick pigs A pig is humanely euthanized and sent to Frederick County Animal Health Laboratory (FAHL) for a necropsy Tuesday, September 26: NVSL reports all 11 samples are positive for H3N2 MDH reports 12 children with ILI clinical signs at the Frederick County Fair 112 pigs left on Frederick County Fairgrounds under strict biocontainment/biosecurity protocols 3-4H Frederick County premises are inspected. Hold Orders placed and 6 pigs are swabbed

14 TIMELINE (CONTINUED) Wednesday, September 27: the Hold Order is released on the 60 pigs at the Charles County Fair The Delaware County Health Department reports that a young adult is positive for H3N2v after visiting the Anne Arundel County Fair There were no clinical pigs observed at the AA County Fair SAHL reports that the 6 pigs from the 3 Frederick County premises are IAV positive Thursday, September 28: MDH reports that the 12 children with ILI clinical signs are positive for H3N2v

15 TIMELINE (CONTINUED) Friday, October 6: The Hold Order is released on the 112 pigs at the Frederick County Fair Tuesday, October 10: Animal Health Program and USDA, APHIS, VS meet for lessons learned discussion Wednesday, October 11: The Hold Order on the 3-4H Frederick County premises are released

16 2017 SWINE INFLUENZA FINAL REPORT 15-4H swine exhibitors with H3N2 clinical pigs 24-H3N2 clinically positive pigs 2-pigs died (1 euthanized) 40-children positive for H3N2v 15 exposed at the Charles County Fair 1 exposed at the Anne Arundel County Fair 24 exposed at the Frederick County Fair 2 children hospitalized (1 from the Charles County Fair and 1 from the Frederick County Fair)

17 2017 Maryland Variant Influenza Outbreak Investigation Monique Duwell, MD, MPH CDC Epidemic Intelligence Service Officer Maryland Department of Health Infectious Disease Epidemiology and Outbreak Response Bureau

18 Variant Influenza Image: Larry Jacobsen/Flickr CC BY

19 Overview of actions IDENTIFY patients with ILI and recent swine exposure TEST Suspect cases for influenza INTERVIEW patients with confirmed variant influenza

20 Case finding

21 Confirmed case Testing completed Reached by health care system People with variant influenza Case Finding

22 22 Epidemic Curve

23 Summary of H3N2v Cases Fair attended Case count Charles County Fair 15 Anne Arundel County Fair 1 Great Frederick Fair 24 TOTAL 40 23

24 Demographic Characteristics Cases (n=40) % Sex Female Male County of Residence Frederick (MD) Charles (MD) Calvert (MD) St. Mary s (MD) Sussex (DE)

25 Age distribution 30 Number of cases Vast majority of patients were children 60% under age 5 years 0 0 <5 10 <15 50 <55 75 <80 Age (years)

26 Risk for Influenza Complications Image:

27 High Risk Groups Cases (n=40) % Under 5 years Over 65 years Chronic illness % of patients at high risk for flu complications 27

28 Incubation Period Number of Cases Charles Fair Anne Arundel Fair Frederick Fair Number of days between most recent swine exposure and symptom onset

29 Clinical Symptoms Cases % Fever Cough Sore throat

30 Swine Exposure Image: Springfield News-Sun Image: The Independent/Barrett Stinson

31

32 Type of Swine Contact Direct Indirect 100 % Percentage of Cases % 60 % % 20 % 26.7% 73.3% 41.7% 58.3% % More than 1/3 of cases had NO direct contact 0 % Charles County Fair (n=15) Great Frederick Fair (n=24) Anne Arundel Fair (n=1) 32

33 Type of Fair Participation Fair visitor Swine exhibitor Percentage of Cases 100 % 80 % 60 % 40 % 20 % 53.3 % 46.7% 83.3% % Nearly 3/4 of patients were fair visitors 0 % Charles County Fair (n=15) 16.7% Great Frederick Fair (n=24) Anne Arundel Fair (n=1) 33

34 Outcomes

35 Clinical Outcomes 2 hospitalizations All patients recovered 35

36 2017 Maryland Outbreak in Context

37 Total Variant Influenza Cases in U.S. Maryland U.S

38 U.S. H3N2v Cases by Year 400 Number of Cases Year

39 2017 H3N2v Cases Other states 22 Maryland 39

40 Prevention

41

42

43 Key Takeaways Those at high risk for influenza complications comprised the majority of cases in this outbreak (75%) Indirect contact with swine is a significant risk factor for contracting variant influenza Variant influenza caused serious, life-threatening illness during this outbreak

44 NATIONAL SWINE INFLUENZA RESEARCH DATA

45 DR. ANDREW BOWMAN et al OHIO STATE UNIVERSITY DEPARTMENT OF VETERINARY PREVENTATIVE MEDICINE Swine influenza transmission at Midwest Agricultural Fairs and Transmission to Humans % of swine entering a Midwest fair were positive for IAV. 60%-90% of swine were positive for IAV after 72 hours. Poor ventilation, increased stock density and comingling pigs for weighing and washing contributed to the spread of IAV. Widespread Influenza-Like Illness (ILI) in these fair pigs was NOT observed

46 THE 2017 H3N2 IS A NEW STRAIN! TRANSMITTED FROM HUMANS BACK IN

47 WHAT ARE THE LESSONS LEARNED? WHAT CAN WE DO FOR NEXT YEAR? A real concern about H3N2 being transferred to vulnerable fair visitors Pre-testing and preventative vaccination for H3N2 will not help After 72 hours, the majority of the pigs are positive for H3N2 Heat stress, increased stock density and commingling increases the transmission of H3N2

48 MDA RECOMMENDATIONS for 2018 MARYLAND FAIRS AND SHOWS Pre-event meetings-establishing contacts-alerts-training Establish a local veterinary presence on fairgrounds and on call for emergencies Shortening the time and order of exhibition by type at the event Establish ways to keep fair animals and barns well ventilated with reasonable stocking density Update internal animal disease emergency plans- e-coli plan Warning signage and developing public traffic flow patterns throughout the barns

49 EXAMPLES OF SIGNAGE FOR FAIR VISITORS

50

51

52

53

54 HANDWASHING STATIONS

55 REFERENCES MDA website: AvianFlu.aspx National Association of State Public Health Veterinarians; 2013 Compendium on Measures to Prevent Disease in Public Settings: nasphv.org/documents/ AnimalContactCompendium2013.pdf Measures to Minimize Influenza Transmission at Swine Exhibitions:

56 MORE REFERENCES Centers for Disease Control and Prevention swine influenza, including posters and other educational materials: flu/swineflu/index.htm National Pork Board Swine Influenza Materials for Exhibitors and Visitors to Fairs: public-health/influenza/

57 DISCUSSION