Measures t Minimize Influenza Transmissin at Swine Exhibitins It is estimated that 150 millin peple visit agricultural fairs each year in Nrth America. Agricultural exhibitins prvide valuable educatinal venues fr the public. Equally imprtant, the exhibitin f swine is an imprtant learning pprtunity fr thusands f yuth exhibitrs, 4-H and FFA members acrss the United States. Shwing swine fr these yuth at their cunty r state fair is the culminatin f many mnths f wrk dedicated t the care and training f their animal. Pigs can be infected with human, swine and avian rigin influenza A viruses. While rare, influenza A viruses can spread frm pigs t peple and frm peple t pigs, but it usually requires clse cntact between pigs and peple. This has happened in different settings, including agricultural fairs. When peple are infected with swine rigin influenza A viruses, it is termed as a variant virus infectin and dented with a v after the subtype (e.g. H3N2v). In the past 5 years, cases f influenza A H1N1v, H1N2v and H3N2v have been assciated with swine exhibitins. In 2011 there were 12 cases f H3N2v reprted frm 5 states. In 2012 there were a ttal f 309 cases f H3N2v identified in 12 states. The majrity f cases reprted expsure t pigs prir t nset f illness and were exhibitrs and thers in clse cntact with pigs at agricultural fairs. Sixteen f these individuals were hspitalized and ne death was reprted. Eleven f the 16 hspitalized cases, as well as the persn wh died, were peple cnsidered t be at high risk fr cmplicatins frm influenza infectins. Peple at high risk include children yunger than 5 years f age, peple 65 years f age and lder, pregnant wmen and peple with certain lng-term health cnditins (like asthma, diabetes, heart disease, chrnic respiratry disease, weakened immune systems, and neurlgical r neurdevelpmental cnditins.) These cases led t the frmatin f the Swine Exhibitins Zntic Influenza Wrking Grup that has develped a set f measures t minimize influenza virus transmissin between swine, frm peple t swine, and frm swine t peple at swine exhibitins. Influenza viruses are unpredictable and their impact and circulatin can vary by year. It may nt be pssible t prevent all transmissin f influenza viruses at swine exhibitins. The measures described here are ffered fr careful cnsideratin depending n the needs f the specific exhibitin and can be implemented in part r in ttal. They are nt intended t supersede federal, state, r lcal regulatins. These measures were frmulated based n current evidence and the cllective knwledge f the Swine Exhibitins Zntic Influenza Wrking Grup. It is expected that this dcument will be updated regularly as additinal infrmatin becmes available. The suggested measures have been rganized t address activities befre, during, and after swine exhibitins. Measures are further divided int actins that may minimize risk t swine and risk t humans, althugh there is significant verlap between thse tw grups. 1
Measures t Cnsider BEFORE the Exhibitin Each state shuld establish and maintain a cmmunicatin netwrk that includes the state animal health agency, state and lcal public health fficials, exhibitin rganizers and managers, veterinarians, Cperative Extensin Service educatrs, vcatinal agriculture instructrs and ther stakehlders. State animal health fficials in cllabratin with state public health fficials shuld determine a testing prtcl fr swine with clinical signs cnsistent with influenza and establish a methd t distribute any test results t the apprpriate animal health and public health agencies. Swine Measures Fr Exhibitin Organizers: Limit the time pigs are cngregated and c-mingled at an exhibitin. Measures might include: Shrten the ttal time pigs are n the exhibitin grunds, ideally exhibitin swine shuld be n the exhibitin grunds n mre than 72 hurs. Release pigs frm the exhibitin grunds as sn as pssible fllwing their respective shw(s). If ffering bth terminal pig and breeding swine shws, schedule the terminal shw after the breeding swine shw r schedule a break between shws. Use this break t clean and disinfect the facility. Lcate lnger-term swine exhibits (i.e. Big Bars, birthing center animals, display exhibits f pigs) away frm areas where the cmpetitin swine are hused. Establish a relatinship with a veterinarian wh will be present r n call fr the duratin f the exhibitin. The veterinarian will be respnsible fr mnitring the animals fr clinical signs, evaluating sick animals and taking additinal steps as warranted t minimize the risk f influenzalike illness in the swine. Establish a prtcl t immediately remve sick swine frm the exhibitin area. Maintain recrds f individual swine identificatin and surce farms t enhance the speed and accuracy f an animal disease investigatin assciated with the exhibitin. Fr Exhibitrs: Cnsult a veterinarian t understand and implement applicable bisecurity and swine health practices at hme. Becme familiar with the clinical signs f influenza A in swine (fever, anrexia, lethargy, nasal discharge and cugh). Seek veterinary assistance if a pig becmes sick. Understand the risks t bth humans and animals f taking a sick pig t an exhibitin. Ask the exhibitin rganizer abut any specific actins that may be required if a pig becmes sick at the shw. 2
Refrain frm shwing a pig and herd mates fr at least seven (7) days after returning frm an exhibitin t reduce the risk f spreading influenza. Discuss the use f swine influenza vaccines with a veterinarian. Vaccines are available cmmercially and may be used prir t an exhibitin. Swine vaccinated fr influenza may be less likely t becme ill, and if they becme sick, they may be cntagius fr a shrter time. Human Measures It is recmmended by the Centers fr Disease Cntrl and Preventin (CDC) that everyne 6 mnths f age r lder be vaccinated annually against seasnal influenza. Seasnal influenza vaccine is usually distributed in late summer and early fall, and peple shuld be vaccinated as sn as the vaccine becmes available. Peple at high risk fr develping mre severe cmplicatins frm influenza include the fllwing: children yunger than 5 years ld, peple 65 years f age and lder, pregnant wmen, and peple with certain lng-term health cnditins (like asthma, diabetes, heart disease, chrnic respiratry disease, weakened immune systems, and neurlgical r neurdevelpmental cnditins). Peple in these high risk grups shuld limit their expsure t infected swine. Fr Exhibitin Organizers Establish methds t rapidly cmmunicate (i.e. email addresses and/r phne numbers frm shw entry infrmatin, scial media channels, etc.) with exhibitrs abut prcedural changes r incidents assciated with the exhibitin. Hst nn-animal-related activities (i.e. dances, pizza parties, etc.) in lcatins ther than animal barns. Fr Exhibitrs Understand that pigs and peple can becme infected frm sick peple. Peple with influenza-like illness shuld stay away frm pigs until they are fever-free fr at least 24 hurs withut the use f fever-reducing medicatin. Measures t Cnsider DURING the Exhibitin Swine Measures Fr Exhibitin Organizers Hst a meeting with exhibitrs and their family members prir t the start f the exhibitin t d the fllwing: 3
Prvide cntact infrmatin fr the designated exhibitin veterinarian. Prvide instructins n hw t reprt animal illnesses and explain any specific actins that may be required if a pig becmes sick at the shw. Prvide cntact infrmatin fr a public health fficial wh can answer public health questins and be available during the exhibitin. Review exhibitin regulatins. Review and encurage disease cntrl measures t be utilized during the exhibitin, including the daily mnitring f the animals during the shw, as well as fr when the exhibitr returns hme. Fr Exhibitrs Observe swine daily fr signs f influenza-like illness, which may include fever, lethargy, lack f appetite, nasal discharge r cugh. Reprt any influenza-like illness t the designated exhibitin veterinarian r the apprpriate exhibitin staff s the pig can be evaluated. The designated veterinarian shuld cnsider testing swine with signs f influenza-like illness. Results shuld be shared with animal health and public health fficials. Swine deemed t be ill shuld be remved frm the exhibitin immediately. Use precautins when caring fr sick pigs t minimize the pprtunity fr influenza transmissin t ther swine r peple. Human Measures Fr Exhibitin Organizers Prvide easy access t hand washing statins. Pst infrmatinal signage that includes the fllwing messages: N eating r drinking in the animal areas Wash hands frequently N pacifiers, sipping cups r strllers in the animal areas Discurage sleeping in the animal areas. If human r swine influenza-like-illness is assciated with the exhibitin, animal health and public health fficials shuld be ntified immediately. Public health fficials shuld facilitate human testing fr influenza viruses, including variant influenza viruses, investigate the surce f illness, and attempt t identify additinal human cases. If illness is detected in swine r humans, public health recmmendatins include: Peple wh have influenza-like illness shuld leave the exhibitin immediately and seek medical care. They shuld advise their health care prvider abut their expsure t swine. Peple at high risk fr develping mre severe cmplicatins frm influenza, as listed abve, shuld be discuraged frm entering the swine areas. 4
Measures t Cnsider AFTER the Exhibitin Swine Measures Fr Exhibit Organizers Clean and disinfect the swine exhibitin areas. Fr Exhibitrs Islate and bserve animals fr illness after returning hme and befre allwing cntact with ther animals The islatin/bservatin perid fr clinical signs f influenza shuld be n fewer than 7 days Clean and disinfect equipment, clthing, shes, and vehicles/trailers that were at the exhibitin. Cnsult a veterinarian if swine becme ill. Human Measures Cnsult a health care prvider and a public health fficial as sn as pssible if exhibitrs r family members develp influenza-like illness Infrm the health care prvider f clse cntact with swine and/r exhibitin attendance. Ill peple shuld avid all cntact with swine until they are fever-free fr at least 24 hurs withut the use f fever-reducing medicatins. 5
Resurces: Centers fr Disease Cntrl and Preventin: http://www.cdc.gv/flu/swineflu/ http://www.cdc.gv/flu/swineflu/h3n2v-cases.htm http://www.flu.gv/abut_the_flu/h3n2v/index.html# http://www.flu.gv/symptms-treatment/symptms/index.html# http://www.cdc.gv/flu/swineflu/h3n2v-factsheet.htm http://www.cdc.gv/flu/pdf/swineflu/fair_exhibitr_factsheet.pdf Natinal Prk Bard Influenza Resurces: http://www.prk.rg/resurces/1389/influenza.aspx A Champin's Guide t Yuth Swine Exhibitin - Natinal Prk Bard (will be updated nline and in print in 2013): http://www.prk.rg/filelibrary/npb%20a%20champins%20guide%20t%20yuth%20swine%20exhib itin.pdf Natinal Prk Bard Yuth PQA (will be updated nline and in print in 2013): http://www.prk.rg/certificatin/21/yuthpqaplus.aspx USDA Swine Influenza Virus (SIV) Surveillance Prgram Infrmatin: http://www.aphis.usda.gv/animal_health/animal_dis_spec/swine/siv_surveillance.shtml 6
Wrking Grup Members: Dr. Jeff Bender, Minnesta Center fr Influenza Research and Surveillance (MCEIRS), University f Minnesta Dr. Carina Blackmre, Natinal Assciatin f State Public Health Veterinarians Dr. Andrew Bwman, The Ohi State University Dr. Tm Burkgren, American Assciatin f Swine Veterinarians Ms. Marla Calic, Internatinal Assciatin f Fairs and Exhibitins Dr. Dee Ellis, Natinal Assembly f State Animal Health Officials Dr. Lyn Finelli, Centers fr Disease Cntrl and Preventin Dr. Tny Frshey, Natinal Assembly f State Animal Health Officials Dr. Ann Garvey, Cuncil fr State and Territrial Epidemilgists Dr. Chris Hahn, Cuncil fr State and Territrial Epidemilgists Dr. Jennifer Huse, Natinal Assciatin f State Public Health Veterinarians Dr. Jennifer Keman, Natinal Prk Bard Dr. Jhn Krslund, US Department f Agriculture Dr. Lisa Lauxman, USDA, NIFA, Yuth & 4-H Dr. Bret Marsh, C-chair, Natinal Assembly f State Animal Health Officials Dr. David Marshall, Natinal Assembly f State Animal Health Officials Mr. Mike Paul, Natinal Swine Registry Dr. David Pyburn, US Department f Agriculture Dr. Jni Scheftel, C-chair, Natinal Assciatin f State Public Health Veterinarians Dr. Susan Trck, Centers fr Disease Cntrl and Preventin Dr. Timthy Uyeki, Centers fr Disease Cntrl and Preventin March 2013 7