The human animal interface at Minnesota fairs and live animal markets - Dr. Joni Scheftel, State Public Health Veterinarian, Minnesota Department of Health, from the 2013 Allen D. Leman Swine Conference, September 14-17, 2013, St. Paul, Minnesota, USA.
More presentations at http://www.swinecast.com/2013-leman-swine-conference-material
Dr. Joni Scheftel - The human animal interface at Minnesota fairs and live animal markets
1. Swine influenza: the human
animal interface at Minnesota fairs
and live animal markets
Joni Scheftel DVM, MPH, dip ACVPM
State Public Health Veterinarian
Minnesota Department of Health
joni.scheftel@state.mn.us
651-201-5107
September 16, 2013
4. Swine Influenza in People: Previously Rare
• 37 reported cases of swine influenza in
humans from 1958-2005, most with swine
contact, some with probable person-to-person
transmission CID, 2007
• 11 reported cases of triple-reassortant swine
influenza A (H1) from 2005-2009, most with
swine contact, no known person-to-person
transmission NEJM, 2009
5. Human Infections with SIV in MN
• 1996; H1N1; 37 Yr old F; swine contact; fatal
• 2008; rH1N1; 29 yr old F; Live animal
market; hospitalized briefly
• 2009; rH1N1; 29 yr old F; swine worker
• 2010 May; rH3N2; 1 yr old F; Live animal
market
• 2010 Dec; rH3N2; 31 yr old M; Live animal
market
• 2011; rH1N2; 5 mo-old F; no animal
exposure- sick family member
6. Swine-Origin Human Influenza Cases by Year and
Type, Minnesota, 1996-2012
10
Number
of
Hospitaliza2ons
9
8
7
H1N2
H3N2
H1N1
6
5
4
3
2
1
0
Year
8. Confirmed Human Cases of H3N2v in the US,
Number cases
2012 (N = 306)
20
11
107
6
138
4
Date of onset, 2012
Slide from Dr. Sue Trock
9. H3N2v at State and
County Fairs in the US
and at the MN State
Fair during 2012
Slide thanks to Dr. Sue Trock
10.
Human
H3N2v
Influenza
Cases
2012,
(n=
305)
States
with
confirmed
cases
11
Fairs
associated
with
human
cases
39
Confirmed
cases
309
Hospitalized
cases
16
Deaths
1
Slide thanks to Dr. Sue Trock
11. Summary
of
Human
H3N2v
Cases,
2012
• Median
age
=
6
y.o.
(range
4
mo
–
74
y.o.)
– 93%
less
than
18
y.o.
• Most
cases
occurred
in
young
swine
exhibitors
at
county
fairs
with
several
days
exposure
to
pigs
at
a
fair
– 5%
of
cases
were
visitors
to
a
fair
• Incuba2on
period
~
2
–
3
days
• Dura2on
of
illness
~
3
–
4
days
Slide thanks to Dr. Sue Trock
12. Distribu2on
of
H3N2v
Cases
and
Propor2on
of
Persons
with
H3N2v
HI
An2body
Titer
≥40
by
Age-‐Group*
Slide
from
Lynn
Finelli
13. CDC
and
4-‐H
Recommenda2ons,
2012
People
at
high
risk
of
serious
complica2ons
from
the
flu
should
avoid
pigs
&
swine
barns
at
the
fair
this
year
High
Risk
groups
include:
<
5
y.o.;
asthma,
diabetes,
lung
or
heart
diseases,
or
other
long-‐
term
health
condi2on;
pregnant
women;
>
65
y.o.
Slide thanks to Dr. Sue Trock
17. H3N2v and H1N2v Cases in Minnesota, 2012
human H3N2v
human probable H3N2v
human H1N2v
pig H3N2v
pig H1N2v
8
Number of Cases
7
6
5
4
3
2
1
0
H3
H1
H3
H1 H1
H3
H3
Case Onset Date
H1 H1 H1
H3
H1
H3
Minnesota
State
Fair
8/23-‐9/3
H3
18. Why Not Minnesota County Fairs
in 2012 ?
• The in-office test for influenza doesn’t work
for H3N2v
• MDH Health Alert to HCP’s to submit
samples to MDH for special testing of cases
of influenza-like illness went out to clinics
on August 6, after most county fairs had
already occurred
• Or maybe the virus didn’t start to circulate
among show pigs until later in the summer
19. Surprises and Things We Learned
in 2012
• We were looking for H3N2v in swine
exhibitors at the fairs and found it at the
Live Animal Markets
• Instead we found H1N2v in pigs and
people at the fair first
• These were the first human cases of
H1N2v with the pandemic M gene in the
US
20. Good things came out of the
experience…
• Great working relationships between
BAH, MDA, MDH, State Fair, 4H, U of MN,
communications people at all entities
• Know more about the behavior of swine
influenza in people and pigs specifically
at fairs and potential for interventions
21. “Be Healthy at the Fair” Verbiage
• People and animals can share germs
• Wash your hands with soap and water
when you leave the barn
• No food or drink in animal areas
• Remove pacifiers and avoid hand to
mouth contact
• Senior citizens, children under 5,
pregnant women and people with a
chronic health condition or a weak
immune system should take extra care
around animals
23. Swine Exhibitions Group
• Met January 15 and16, 2013
• NASAHO and NASPHV Co-leads
– AASV, CDC, IAFE, USDA, 4H, NPB, Ohio
State U, U of MN, Swine Registry,
NASAHO, and NASPHV
• Audience: Fair/show organizers and
managers, 4H, FFA, Extension personnel,
exhibitors and their families, practicing
vets, animal health and public health
officials
24. Swine Exhibitions Group
• Developed “Measures that may be
considered to minimize transmission of
influenza viruses between swine, between
people and swine and between swine and
people at swine exhibitions”
– Prior to the exhibition
– At the exhibition
– After the exhibition
26. 2013: Increased surveillance for
novel influenza infections
• Sent Health Alert to remind HCP’s to
send nasal swabs for influenza testing
to MDH from people with ILI who report
swine contact
• Set up system for sampling of sick 4H
kids at the state fair (same as 2012)
27. Postcard to 4H Families in the
Swine Project
July
12,
2013
Dear
Swine
Exhibitor
and
Parents:
Just
a
heads
up
that
there
have
been
cases
of
influenza
in
people
showing
swine
or
visiting
the
swine
barn
at
fairs
in
Indiana.
So
far,
no
cases
have
been
identified
in
Minnesota,
but
we
want
to
be
prepared.
As
a
reminder,
if
you
develop
flu-‐like
symptoms
(cough,
sore
throat,
body
aches,
runny
nose,
or
fever)
within
a
week
of
the
fair
please
talk
to
your
doctor
and
ask
to
have
a
nasal
swab
sent
to
the
Minnesota
Department
of
Health
for
testing.
If
you
have
questions
about
flu
in
pigs,
please
contact
the
Minnesota
Board
of
Animal
Health
at
651-‐201-‐6844;
if
you
have
questions
about
the
flu
in
people,
please
contact
the
Minnesota
Department
of
Health
at
651-‐201-‐5414.
For
information
on
measures
you
can
take
to
keep
your
pigs
healthy
before,
during,
and
after
the
fair,
please
go
to:
http://usaha.org/.
Sincerely,
Beth
Thompson,
JD,
DVM
Joni
Scheftel,
DVM,
MPH
Senior
Veterinarian
State
Public
Health
Veterinarian
Minnesota
Board
of
Animal
Health
Minnesota
Department
of
Health
28. U.S.
Cases
of
Variant
Influenza
A
350
300
Cases
250
200
150
100
50
0
2005
2006
2007
2008
2009
Year
2010
2011
2012
2013
29. Swine-Origin Human Influenza Cases by Source of
Infection, Minnesota, 1996-Sept 14 2013
1
2
1
7
Live Animal Market
Fair
Swine Farm/Industry
Person-to-Person
Unknown
6