A Look Back at the New Hampshire Hepatitis C Outbreak

May 16 2013 :: Published in Infectious Diseases

By Celia Hagan, Manager, HIV, Hepatitis, STD, TB Programs, APHL

A Look Back at the New Hampshire Hepatitis C Outbreak | www.aphlblog.org

People often associate hepatitis with intravenous drug use or getting tattoos or piercings at dirty parlors.  They think it’s something that can’t happen to them. However, recent health-care associated outbreaks in Oklahoma and New Hampshire show that hepatitis is something that we all need to be aware of.  The New Hampshire case, in particular, demonstrated how a rapid public health response can identify a hepatitis C outbreak and stop transmission.

In the spring of 2012, the New Hampshire Department of Health and Human Services, Division of Public Health Services began investigating a cluster of four people who were recently diagnosed with hepatitis C and who had been treated at the same hospital. The public health laboratory initially coordinated blood draws and performed hepatitis C virus (HCV) testing. Additionally, the public health lab performed DNA sequencing on the non-structure 5B region of the HCV genome to subtype the virus and sequenced the hypervariable region 1 of the HCV genome to determine if individuals who were infected were part of the same outbreak. When sequencing was performed on the initial cluster, the four individuals had matching HCV viral sequences indicating a common source of infection.

As the outbreak unfolded over the next few weeks, mounting evidence suggested that the mode of transmission was a drug diversion by a cardiac catheterization laboratory technologist at Exeter Hospital. The technician is accused of stealing Fentanyl syringes intended for patients, injecting his own arm, refilling the empty syringes with a saline solution, and returning the used syringes as if they were untouched. Those dirty needles were then used on patients.

Dr. Christine Bean, New Hampshire’s public health laboratory director, and Dr. Fengxiang Gao, New Hampshire’s public health laboratory virology and special testing program manager, said that in the initial phase of the investigation, where the primary concern was focused on testing patients who received care at the cardiac catheterization laboratory of Exeter Hospital, the laboratory tested 1,072 specimens. This was well over their normal testing volume of about 200 specimens per month. All testing was performed at the public health laboratory and positive specimens were sent to CDC for additional testing.  When the investigation expanded to other units in the hospital that the technician had access to, an additional 3,300 patients needed testing. Community testing centers were set up to assist with rapid blood draws. In addition to the routine testing done at the public health laboratory, the clinics offered rapid HCV testing on site and also trained sentinel laboratories on rapid testing to help with the volume. Ultimately, 32 patients were identified as part of the NH outbreak, in addition to the infected technician. As the outbreak investigation expanded to include other states where the technician had previously worked, additional cases were found.

The Molecular Diagnostics group at New Hampshire's Public Health Laboratory. This group did the hepatitis C (HCV) sequencing during the 2012 outbreak to determine the HCV subtype and HCV genetic relatedness. | www.aphlblog.com

The overall response to the outbreak from the laboratory was phenomenal.  Quick detection may have prevented additional infections. Dr. Bean emphasized that their success in responding to the outbreak depended on a strong public health laboratory system—the public health laboratory and epidemiologists working together and the public health laboratory’s capability and capacity to perform both serology and molecular tests for HCV.

In the May 10, 2013 issue of MMWR, CDC released Testing for HCV Infections: An Update for Guidance for Clinicians and Laboratorians. The updated guidelines emphasize identifying persons with current HCV infections as opposed to those who have had past infections that have been resolved and encourage laboratories to utilize newer testing technologies. The new recommended testing sequence includes an initial test with an FDA-approved test for HCV antibodies, followed by an FDA-approved nucleic acid test (NAT) intended for the detection of HCV RNA in serum or plasma if the initial serology assay is reactive.

May 19, 2013 marks the second National Hepatitis Testing Day during a month that is already dedicated to raising the awareness of viral hepatitis. The day is committed to testing people at risk for hepatitis and to educating providers and the public about chronic viral hepatitis and testing.

To find a Hepatitis Testing Event near you or to register your event, click here.

 

 

 

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World TB Day: What’s in a name?

Mar 24 2013 :: Published in Infectious Diseases

By Will Murtaugh, Specialist, Infectious Diseases, TB Programs, APHL

Robert KochWorld TV Day, you say?!  Sorry, unfortunately not. But since you’re here – let’s talk about World TB Day!  So hit pause on Contagion (you know you’ve already seen it umpteen times), take a look at this guy, and read on.

This German man with the enviable uber-beard once gave an uber-exciting lecture titled “Über Tuberkulose” describing how he discovered the bacilli that causes tuberculosis (TB). He eventually won a Nobel Prize for his discovery, and now, on World TB Day, we’re supposed to celebrate!

Not yet convinced to throw on that party hat? OK, so he’s no Jude Law and maybe this wasn’t the blockbuster climax you were looking for – but the story of “Über Tuberkulose” is far from over…

Imagine that you were this shrewd-looking man surrounded by people who still believed they lived in a “miasma” filled world that caused 1 in 7 people to die with a combination of symptoms including fever, weight loss, and a prolonged productive and bloody cough.  What if this was happening to 7,000,000 people worldwide every year?  What if it was believed incurable and treatment involved being sent away in isolation to a “sanatorium” with a prescription of more fresh air?  You’d surely say,

“…my words have been unheeded. It was still too early, and because of this they still could not meet with full understanding. It shared the fate of so many similar cases in medicine, where a long time has also been necessary before old prejudices were overcome and the new facts were acknowledged to be correct….”

Or something like that – right?

This was the reality of 131 years ago.  But you can thank your lucky pipettes for a “19th Century scientist giving a speech about discovering germs in a laboratory” that the miasma fog has lifted and exposed the road to TB elimination we continue down today; one in which we can demand, “Stop TB in my lifetime”.  Specifically, you can thank Dr. Robert Koch for revealing to the world on March 24, 1882, in an oft romanticized speech, still considered one of the greatest in medical history, that TB was caused by an identifiable infectious agent, Mycobacterium tuberculosis.

So, what’s in a name?

In the case of M. tuberculosis, an infectious bacilli likely as old as mankind itself, a lot. So don’t throw on your party hats just yet.  Part of observing World TB Day is that we recognize we are still a long way from TB elimination. In 2013, we face a different set of challenges than those of 1882:

  • An increasingly mobile global community in which one-third of its population are believed to be carriers of M. tuberculosis.
  • The emergence of Multi-Drug Resistant (MDR-TB) and Extensively Drug Resistant (XDR-TB) strains of M. tuberculosis induced by improper use as a result of an expensive and long-term treatment program.
  • Systemic societal issues, including marginalized high-risk populations such as persons co-infected with HIV, foreign-born persons, the homeless and those in America’s prison system.

We recognize the progress of science, medicine and public health that has contributed to the global reduction of TB and remember Dr. Koch’s fundamental contribution in naming M. tuberculosis. Specifically here at APHL, we recognize its impact on the development of TB diagnostics used in our public health laboratories today.  Koch contributed to the development of a widely used test for detecting TB infection, the tuberculin skin test (TST, also known as PPD or Mantoux test).  Additionally, he successfully developed a method to both grow and visualize M. tuberculosis that was so valuable similar methods are still used by our public health laboratories to aid in the diagnosis of TB.  As our Mycobacteriology laboratories progress forward, detecting M. tuberculosis with faster, and more advanced technologies, they evaluate many of these tests against the methods pioneered by Koch.  Furthermore, laboratories are developing the capability to “name” M. tuberculosis in greater detail, revealing important information such as the strain responsible for an outbreak and the presence of MDR and XDR-TB.  The value of these laboratory capabilities is becoming increasingly apparent as we overcome the evolving and often overlapping challenges. Important instances of the laboratories’ continued relevance in TB control in the United Stated can be found in still ongoing events such as the outbreak in a largely homeless population in Los Angeles’s Skid Row and the detainment of a Nepalese man in McAllen, TX diagnosed with XDR-TB.

So not to worry, Dr. Koch, with the help of those funny lenses of yours, our public health laboratories see the way forward.  Party hats on!

To learn more about public health laboratories and TB, check out APHL’s TB page.  Additional information and resources for World TB Day and related events can be found at CDC’s dedicated website.

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The Newest SuperBug: CRE

Mar 21 2013 :: Published in Infectious Diseases

By Laura Iwig, Senior Specialist, Infectious Disease Program, APHL

What is this new antibiotic-resistant superbug that is flooding the news streams these days?  Nightmare bacteria?  Triple threat?  What is this monster?

On March 5, 2013, CDC’s Vital Signs featured a report describing the newest superbug circulating health care facilities around the world: Carbapenem Resistant Enterobacteriaceae (CRE). It has targeted patients in health care facilities receiving care that requires devices such as ventilators, urinary catheters, or intravenous catheters.  People receiving these treatments are immunocompromised and more susceptible to other infections.  Symptoms can include gastrointestinal illness, pneumonia, or, in serious cases, infections of the bloodstream or other organs.

Hospital bed

CRE is unlike other antimicrobial resistant bacteria.  As Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, stated “They’re resistant to nearly all antibiotics. They have high mortality rates, killing half of people with serious infections. And they can spread their resistance to other bacteria.”

Most health departments are only beginning to look for CRE.  Many report health care-associated infections only when there is an outbreak.  As indicated in the MMWR article, only six states require facilities to report CRE infections!  This means that the true impact of CRE is not known.

What are public health laboratories doing in response?

Depending on the presence of CRE in their state, public health laboratories are either working to respond or preparing for an influx of testing orders.  The Colorado public health laboratory, for example, has collaborated with state epidemiologists to implement CDC screening procedures for CRE in response to an outbreak at a Colorado hospital.  To date, the lab has screened a total of 126 swab samples for the presence of CRE, and validated and implemented detection of two CRE genes to support identification of the nightmare bacteria.

At the same time, APHL is assisting public health labs to build CRE testing capability.  In August 2012, the association, in collaboration with CDC, selected the Indiana State Public Health Laboratory and Michigan Public Health Laboratory to develop non-automated antimicrobial susceptibility testing capability for CRE to provide confirmatory testing for clinical laboratories.  These critical projects are well underway; it is in the public’s interest to ensure that they are sustained.

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Presenting APHL’s New Animated Video!

Oct 31 2012 :: Published in General

What is a public health laboratory? Hopefully this will help answer that question. If you cannot see the video below, click here.

Thanks to Digital Bard for their hard work on this video!

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Beware of the Nose Pickers

Oct 16 2012 :: Published in Food Safety, Infectious Diseases

By Kara MacKeil, BA, Senior Technician, Public Health Preparedness and Response, APHL

Let’s all stop and think for a moment about why you, personally, should wash your hands.  We all agree that washing your hands is a good thing; according to the US Agency for International Aid, good hand washing can reduce death from diarrheal disease by almost half.  But you may notice that “I know I should wash my hands” often does not equal “I DO wash my hands.” (Feel free to read this if you don’t believe me.)  So in the interests of public health, I’m going to do my best to scare you all into picking up the soap.

Nose Picker

Picture the handle on the front door of your workplace (if yours doesn’t have one, skip ahead to the elevator buttons).  Who might have used this handle before you arrived this morning?  What have they all been touching before they came to work? Many have small children at home; conceivably they changed a diaper or dealt with an accident before they left the house.  Almost certainly they used the bathroom themselves.  There are numerous pet-owners, perhaps they did the morning walk or scooped a litter box. It’s cold season, so quite a few have been coughing and sneezing, and just as many have spent the last hour sitting in traffic with their index fingers shoved firmly up their nostrils.  They might have hit the sink, they might have used hand sanitizer, but they all touched that handle before you did.

Go inside and walk to your desk.  Notice that the cleaning crew has thoughtfully dusted underneath your various pencil holders, convention toys, and other objects.  How nice!  I’m sure they washed their hands before they picked up the mouse you’re about to spend all day holding. The rest of the day passes as usual.  You touch buttons on the copy machine and objects on your desk.  You pick up a pen, and wonder idly how you came to own it, since you didn’t attend the convention it advertises.  Someone must have left it on your desk.  Wonder what they touched?

Lunchtime hits, and you eat with your co-workers.  Hopefully everyone washed their hands, especially the one passing out cookies.  After lunch it’s more buttons, more objects, more mystery pens.  Someone coughs in the background, jolting you from your post-lunch stupor, and you hit the candy jar for a boost.  Just be sure to get to it before the cougher does.

You use the bathroom.  Uh-oh, there’s another door handle.  Are you sure you heard the sink when the last person finished?

Work is done, so it’s time for errands, or maybe the gym. Whatever you do, you’ll be touching things. More door handles, more objects, more nose pickers. On the way home, you realize your EZ pass isn’t in the car, and you’ll have to use cash.  Amazing how long a coin lasts, I bet THOUSANDS of people have touched that!

Here’s your front door, safe at last!  It’s late, so crawl into bed, maybe read a few pages of that great book you snagged from the secondhand bookstore.  As you drift off, try not to think about how many things you have touched today, and all the hands that touched them first. Pay no mind to all those times you touched your face.

Wash your hands!

 

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Improving Outbreak Response with FoodCORE: an Introduction to Food Safety Success Stories

Oct 11 2012 :: Published in Food Safety

By Jessica A. Monmaney, Senior Technician, Food Safety and Infectious Diseases, APHL

A few months ago, you may have heard about an ongoing and growing Salmonella outbreak. By the end of the outbreak, there were 425 people sick across 28 states, and 55 people hospitalized. However, without the quick action by the states and cities involved, many more people could have become ill. In large part due to CDC’s Foodborne Diseases Centers for Outbreak Response Enhancement (FoodCORE) program, the outbreak’s cause was identified as scraped raw frozen tuna and further illnesses were prevented.

FoodCORE is a program that started in 2009 and is currently made up of 7 centers: Connecticut, New York City, Ohio, South Carolina, Tennessee, Wisconsin and Utah. FoodCORE finds solutions to outbreaks more rapidly through a system of comprehensive interviews, prompt DNA fingerprinting of pathogens and efficient information sharing among partners. Interviews with sick individuals regarding recent food consumption allow FoodCORE centers to identify potentially contaminated products, fingerprint the DNA of the bacteria and combine information to determine what made people sick.

PulseNet Logo

At the 16th Annual PulseNet and 8th Annual OutbreakNet Update Conference, the FoodCORE team provided crucial input/participation throughout numerous facets of the conference as a whole, and collaborated for a member networking session and an open session. The following people deserve a round of applause for their efforts leading up to, and throughout, the conference: Jennifer Mitchell, Julia Hall and Kim Quinn as General Session moderators; Katie Garmin, Marilee O’Connor and Jenni Wagner as Regional Breakout Session Facilitators; Heather Hanson, HaeNa Waechter, Jeannette Dill, Amy Woron, Katie Garmin, Tim Monson and David Young as speakers and poster presenters; and all of the FoodCORE members who took the time to engage PulseNet and OutbreakNet partners during the Sunrise Sessions and the Q&A portions of the General Sessions.

The FoodCORE Members Networking Session was attended by over 40 people, including staff from FoodCORE centers, as well as partners from CDC’s Outbreak Response and Prevention Branch, leadership and sites from FDA’s Rapid Response Team (RRT), APHL and the Public Health Agency of Canada. Center participants met in small groups to discuss center-specific future goals and upcoming projects. Attendees successfully concluded the meeting in agreement on team-wide projects and goals, such as improving the process of reporting metrics and the development of model practices documentation.

An open session on the first day of the conference provided over 70 conference attendees with the opportunity to become more familiar with FoodCORE and the lessons learned while resolving outbreaks that lead to success stories. In addition to the raw scraped tuna outbreak, the Ohio state lab created an innovative way to provide information on norovirus infection and protection through social media, New York City used their a “Team Salmonella” to solve an outbreak of Salmonella related to kosher chicken livers, and Utah utilized FoodCORE resources to resolve an outbreak of Salmonella in queso fresco that had stumped state public health officials for two years. For more details on these outbreaks – including interviews with staff at FoodCORE centers from the frontlines of these success stories – please stay tuned for the upcoming fall issue of APHL’s Lab Matters!

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What We’re Reading

Sep 06 2012 :: Published in What We're Reading

Did you know that this month is both Newborn Screening Awareness Month AND National Preparedness Month?  Talk about a busy public health month!  Make sure to subscribe to this blog to see all of our great posts on both topics.

In other news…

  • Leading the public health response to global outbreaks – This is a profile of Dr. Ali Khan, Assistant Surgeon General and Director of the Office of Public Health Preparedness and Response. Dr. Khan is a great partner, leader and friend to APHL.  Terrific article by the Washington Post.
  • Whooping Cough Reaches Epidemic In Bluegrass – Whooping cough (aka, pertussis) continues to spread around the nation.  There is news about this outbreak from almost every state; this article is about Kentucky.
  • Yosemite hantavirus warning expands to 39 countries – Six visitors to Yosemite National Park have been confirmed to have contracted the disease from infected mice there — two have died.  CDC estimates that around 10,000 people may have been exposed after staying in cabins at the park this summer.
  • Rare Colorado plague case had Girl Scout near death – A seven year old Girl Scout contracted bubonic plague after coming in contact with a dead squirrel.  As she asked her parents for a proper burial for the squirrel, they suspect fleas from the animal made their way onto her sweat shirt which she then tied around her waist.  Long story short, after facing death herself, the  young animal lover is recovering well.
  • Top American Science Questions: 2012 – Given the recent political conventions, this seemed appropriate to share.  Governor Romney and President Obama were both presented with what this group deemed the most important science questions facing the nation.  You can see their answers side-by-side on topics ranging from climate change to pandemics and biosecurity to space.

 

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Avoiding Arboviruses — Don’t Let the Bugs Bite

Sep 04 2012 :: Published in Infectious Diseases

By Celia Hagan, Senior Specialist, Infectious Disease Programs, APHL

Arboviruses (arthropod borne viruses) have been all over the news lately. You’ve heard of the West Nile virus outbreak this year, a mosquito-borne disease that causes fever, headaches, body aches and potentially serious illnesses such as West Nile encephalitis and West Nile meningitis. To date, CDC reports 1,118 cases of West Nile in 42 states, including 41 deaths. Given that this is the most cases detected through the first three weeks of August since the disease was first detected in 1999, 2012 is well on its way to being the largest West Nile outbreak in the United States. There is also concern about Eastern equine encephalitis, commonly known as EEE, another mosquito borne virus that can cause severe illness in humans. That pesky mosquito bite is now something to be more concerned about.

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The mosquitoes have kept the Massachusetts Bureau of Laboratory Sciences working hard as their state has been hit especially hard this summer.  EEE has been in Massachusetts since 1938 and the Massachusetts Bureau of Laboratory Sciences has been conducting surveillance since the 1950s.  Dr. Sandy Smole, the Director of the Division of Molecular Diagnostics and Virology says this year has been unprecedented in the amount of testing the public health laboratory is performing.  They have detected arboviruses 3-4 weeks earlier than usual and have more positives than in years past.

Experts think this unprecedented year may be due to the mild winter with no hard freezes to kill off the mosquito populations. The natural cycle of West Nile virus and EEE is between birds and mosquitoes (see graphic) – birds are the reservoir host and are bitten by mosquitoes that pass it on to other birds that are bitten by other mosquitoes that then pass it on to other birds and so forth.  Some of those mosquitoes also bite humans.  In years like this one where there are more mosquitoes than usual, there is a greater likelihood that those mosquitoes that do bite humans will also be carrying one of these arboviruses.  In Massachusetts, the lab typically detects EEE in mosquitoes that bite birds before they detect it in species that also bite humans.  Due to the higher number of mosquitoes, this year it has often been the reverse.

Laboratory personnel at the Massachusetts Bureau of Laboratory Sciences screening mosquito pools for West Nile virus and EEE.

So what exactly does the laboratory do?  Today they work with nine mosquito control projects around the state to monitor arboviral activity in mosquito populations. Mosquitoes are collected over a 24 hour period at different locations around the state primarily using CO2 baited traps with a CO2 canister or dry ice. Surveillance is primarily interested in monitoring the species of mosquitoes that bite humans, so the trapped mosquitoes are sorted by species and sent to the public health laboratory for testing.  Back at the laboratory, Dr. Smole and her team pool mosquitoes into sets ranging from 10-50 mosquitoes. Mosquito pools are then homogenized, centrifuged, extracted and then screened by PCR for EEE and West Nile virus. Positive pools are reported back to the mosquito control projects through a web-based database, wherein recommendations can be made to local boards of health about curtailing evening activities or aerial spraying.

While public health laboratories and health departments work hard to keep the public safe from arboviruses, here are some tips to fight the bite:

  1. Avoid being outside during dusk and dawn when mosquito activity is at its peak.
  2. Wear repellent! Use an insect repellent that contains DEET, oil of lemon eucalyptus, picaridin or IR 3535.
  3. Cover yourself! Wear long pants and long sleeved shirts to avoid bites.
  4. Remove any standing water where mosquitoes like to breed—buckets, flower pots, swimming pool covers, bird baths, etc.

For more prevention tips, visit CDC’s West Nile Fact Sheet.

For more information on Massachusetts’ Arboviral Surveillance program, click here.

 

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What is all the whoop about?

Aug 22 2012 :: Published in Infectious Diseases

By Celia Hagan, Senior Specialist, Infectious Disease Programs, APHL

Infant getting a vaccine (Photo credit: James Gathany)It is National Immunization Awareness Month and what better time to remind friends, family members and coworkers to get their shot and boosters than in the midst of a whooping cough outbreak?  Recently, it seems that whooping cough outbreaks are everywhere.  This year large outbreaks in Washington, Minnesota and Wisconsin have made the national news. According to the Centers for Disease Control and Prevention, more than 22,000 cases of whooping cough have been reported this year and, as of early July, 37 states have reported increases in pertussis as compared to the same time period in 2011.  As of 2010, the US had the highest number of whopping cough cases since 1959, and now we’re even higher.

But what’s all the whoop about? Whooping cough, also known as “pertussis,” is a respiratory tract infection caused by the bacterium Bordetella pertussis, which causes a violent, uncontrollable cough. In younger children a “whoop” noise is often heard when taking a breath through inflamed airways. Although illness is usually not severe in adults, whooping cough can cause serious, sometimes fatal complications in young children and infants. As of August 11th, 13 pertussis-related deaths had been reported in 2012, with the majority of those deaths in infants under 3 months.

With this dramatic increase in pertussis cases, public health laboratories have played a critical role in detecting and responding to outbreaks. Many states are experiencing a greater than threefold increase in whooping cough reporting as compared to last year. This means additional strain on public health laboratories to deal with the influx of testing. Debbie Gibson, the Microbiology and Molecular Laboratory Manager at the Montana Laboratory Services Bureau, says one of the biggest challenges in managing the surge while simultaneously maintaining the routine volume of daily testing. Fortunately, public health laboratories have plans in place to handle increases in volume, and the implementation of new, faster testing technologies has allowed public health laboratories to handle higher volumes of testing in shorter periods of time. Dave Mills, the Laboratory Director of New Mexico’s Scientific Laboratory Division, says that even when dealing with a threefold increase in specimens, the laboratory, which now uses PCR to test for whooping cough, can handle the increased volume efficiently.

While public health laboratories work to detect and respond to outbreaks, there are several things you can do to protect yourself and your family from whooping cough:

  •  Get vaccinated! (DTaP vs Tdap: DTaP is the vaccine given to children under 7 years old to build immunity.  Tdap is the booster vaccine given to people age 11 and older for continued immunity.  They both protect against diphtheria, tetanus and pertussis (whooping cough).) Whooping cough can be life threatening to babies who are too young to be vaccinated, and adults are a common source of infection.  Also consider checking with any caregivers to be sure they are vaccinated. Remember, by getting this one-time booster shot, you not only protect yourself from whooping cough, but newborns as well. CDC recommends adults ages 19-64 who have never received a Tdap vaccine be vaccinated, especially pregnant women and adults who have close contact with infants.
  • Get your kids vaccinated! Talk to your pediatrician to make sure your children are up-to-date with whooping cough vaccines. CDC recommends a dose of Tdap for children 11 or 12; children under 6 years of age should receive four doses of the DTaP vaccine to protect against whooping cough.
  • Wash your hands and cover your cough! Whooping cough is spread through respiratory droplets when coughing, sneezing or talking. Cover your mouth when you cough or sneeze and wash your hands frequently.

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This Little Piggy Went to the Doctor

Aug 21 2012 :: Published in Infectious Diseases

By Michelle Forman, Senior Media Specialist, APHL

Pigs

I love the county fair – I don’t know what I love the most (it’s the fried Oreos) but I love the fair.  I mean, where can you ride a Ferris wheel, eat an entire meal on a stick, watch piglets run a foot-race and see a giant zucchini all in one place?  Only at the fair.

Unfortunately agricultural fairs around the nation have been sending people home with more than just a smile and some oversized stuffed toys.  Hundreds of people have caught a version of the flu from the pigs at the fair.  This little piggy went to the fair… and caught the flu and gave it to hundreds of people…

So what exactly are we talking about here?  H3N2v is a variant of influenza A.  It is not the swine flu we talked about in 2009 – that was H1N1.  This is a different virus although both started by being transmitted from pigs to humans.  From July 12-August 17 of this year, 224 cases of this flu have been reported with over 90% of the cases occurring in kids.  And because this version of the flu has symptoms similar to seasonal flu, it is likely that many cases have not been reported.

How are people catching H3N2v from pigs?  Pretty much in the same way a person catches seasonal flu from another person.  Most people had direct contact with sick pigs, but it can also be spread in the air after a pig sneezes.  Let’s be honest here, folks.  If I was at the fair with my daughter and a pig sneezed, I would almost definitely think it was adorable and hilarious as would my daughter.  Not anymore!  Just like with people-sneezes, pig-sneezes send infected droplets into the air and onto the railing of their pen or the track at the pig races.  If any of those droplets make their way into your nose or mouth, or even onto your hands and then into your nose or mouth, you could get sick.  (If you are not completely grossed-out at this point and are still reading, kudos to you!)

How do you avoid getting H3N2v?  APHL is not in the business of telling you not to go to your state or county fair.  In fact, CDC isn’t telling people that either.  Go! Enjoy! Eat fried Oreos!  Just be careful.

  • Wash your hands with soap and water after being near pigs – not just after touching them, after being in their presence. (That includes the pig races!) If soap and water isn’t available, CDC recommends using an alcohol-based hand sanitizer until you can find soap and water.
  • Do not eat, drink and/or put anything in your mouth while visiting the pigs.  In fact, don’t take any food or drink into the pig barns at all.
  • Don’t take any pacifiers, bottles, sippy cups, toys or anything else a child might put into their mouth into an area where there are pigs.  Leave your stroller with all of your gear outside just to be safe.
  • CDC does recommend that high-risk populations (children under 5 years old, elderly, pregnant women, people with chronic medical conditions, etc.) avoid exposure to pigs altogether.
  • Be a good visitor – avoid the pigs if you are experiencing any flu-like symptoms.  You can give the flu to the pigs too, you know.

Here is some more information from CDC.  Do your community a favor and share it with others.

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