The
Indiana State Department of Health (ISDH), Indiana Board of Animal
Health (BOAH) and the Grant County Health Department are continuing the
investigation of cases of variant influenza A (H3N2v) associated with
the Grant County Fair.
ISDH has also been conducting statewide surveillance since other county
fairs are ongoing and others about to begin. ISDH has received samples
from another county within the state with reports of influenza-like
illness (ILI) among swine exhibitors. Laboratory
results are pending and are expected on Monday July 1st.
According
to BOAH, thirteen pigs at the Grant County fair tested positive for
H3N2. It is not uncommon for infected pigs to be asymptomatic. Pigs
that are ill with influenza typically recover within several days.
Symptoms of H3N2v in humans
include: fever, cough, sore throat, chills, headache, and muscle
aches. Diarrhea and nausea may occur in children. Symptoms usually
start about 1 to 4 days after being exposed and last 2 to 7 days.
Many
county fairs will open in the next few weeks, and the ISDH is
increasing surveillance for ILI. During the week of June 23-29, fairs
are scheduled in the following nine counties: Daviess, Hancock, Marion,
Miami, Rush, Spencer,
Vermillion, Washington, and Wayne. A list of dates and fairs is
available on the ISDH website at
http://bit.ly/1axgXqE.
The
ISDH strongly encourages influenza testing on patients presenting with
ILI, defined as a fever of 100 degrees F or greater and either cough or
sore throat. Nasopharyngeal swab specimens from symptomatic persons who
have attended
a fair or had contact with swine should be sent to the ISDH Laboratory
for polymerase chain reaction (PCR) testing. A negative rapid test does
not rule out H3N2v. For questions regarding specimen collection and
shipment, please contact Katie Masterson, ISDH
Virology/Preparedness Supervisor at 317-921-5843.
To
collect the specimen, insert swab into the nasopharynx until resistance
is felt, and place swab in the tube of viral transport medium. Break
the swab shaft at the scored mark before closing the screw cap tightly.
Label each tube
with the patient's name and the collection date. Transport the
specimen on cold packs for overnight delivery to ISDH Virology Lab. The
following video, available on the New England Journal of Medicine’s
website, is an excellent guide for collecting NP swabs:
http://content.nejm.org/cgi/content/full/NEJMe0903992/DC1
Health
care providers should contact Shawn Richards at 317-233-7740 for
specimen approval prior to submitting specimens to the ISDH Labs. Only
specimens with prior approval will be tested. Submit specimens via
LIMSnet, the ISDH lab's
electronic submission system, if possible. If you do not have an
account, please contact the LIMS Help Desk at 317-921-5506 or
888-535-0011, or e-mail at
LimsAppSupport@isdh.in.gov.
Before specimens are sent, please make sure that all sample tubes are
labeled with the patient's name and ship the specimens to:
Indiana State Department of Health Laboratories
Attn: Virology Lab
550 W. 16th St. Suite B
Indianapolis, IN 46202
When seeing patients with ILI,
please document exposure history for the four days prior to onset of
illness, including contact with animals, and information about friends
or family members with similar illness, including onset time and
dates. Contact your local health department about any patients
presenting with ILI.
Current recommendations from the Centers for Disease Control and Prevention (CDC) on antiviral treatment are located at
http://www.cdc.gov/flu/swineflu/h3n2v-clinician.htm and include:
- Antiviral treatment with oral
oseltamivir or inhaled zanamivir is recommended as soon as possible for
any hospitalized patient and those with evidence of severe complications
or progressive illness suspected to have influenza, including
H3N2v virus infection, without waiting for the results of laboratory
testing.
- Antiviral treatment with oral
oseltamivir or inhaled zanamivir is recommended as soon as possible for
outpatients suspected with influenza, including H3N2v virus infection,
if they are in a group considered to be at high risk for complications
from influenza, without waiting for the results of laboratory testing.
-
Antiviral treatment with oral oseltamivir or inhaled zanamivir is
encouraged as soon as possible for non high-risk outpatients without
underlying medical conditions and suspected to have H3N2v virus
infection, without waiting for the
results of laboratory testing. These persons may benefit from antiviral
treatment, if it can be started within 48 hours of illness onset.
For additional questions, please contact Shawn Richards, ISDH Respiratory Epidemiologist, at 317-233-7740 or
srichard@isdh.in.gov. For after-hours calls, please contact the ISDH Duty Officer at 317-233-1325.
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