not yet….. novel human swine flu event texas 2008 neil pascoe dshs matt cochran tahc
TRANSCRIPT
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Not Yet….
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Novel Human Swine Flu EventTexas 2008
Neil Pascoe
DSHS
Matt Cochran
TAHC
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Program
• Swine flu investigation 2008
• Discuss Pandemic Influenza
• Novel H1N1-2009 (Swine Flu)
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But first a message from our sponsor
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Texas Human Swine Influenza Case
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First Notification 11/3/08 3:21 PM
• Just a heads up. We sent specimen AVI0800070 to CDC on Thursday of last week. It was positive for FLU A but thus far, we have not been able to subtype it. CDC is running additional tests to determine if this is a "true" unsubtypeable Flu A. I expect to hear from CDC tomorrow. And FYI, this could be a reagent issue, but we should know more tomorrow. Thanks - martha– Martha Thompson, MPH– Viral Isolation Team Leader
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Case
• 14 YO male, Gr. 9 HS student• Hx of asthma otherwise healthy• Onset Tuesday 10/14/08 F/ST/cough sent home
from school• Presented 10/15/08 local OP clinic• Fever 103F • Cough, HA, sore throat, conjunctivitis, diarrhea• flu vaccination 2008 (according to mother)
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Household
• Parents and 2 siblings – Brother 12 yo 7th grade– Sister 6 years, 1st grade
• No one else ill
• Cats, dogs, goats, pigs
• Case raises show pigs and recently purchased pigs the previous weekend
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Investigation
• Flu study conducted in Bell County (reason for culture)
• Early in flu season but no increase in ILI• School surveillance showed no increase in
absenteeism• Specimen collected 10/15 sent to DSHS 10/24
(for routine subtyping) and to the CDC on 10/30 • Serum collected 11/6 from all family members
sent to CDC (preliminary results are neg.)
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Texas Swine Influenza Case
• October 11th, 2008 visited:– Plainview, ‘Ring of Success Pig Sale’ (purchased
pig)• This pig originated in Nebraska• This pig had a “light cough” when purchased and a “light
rash” and was “lethargic”– new owners attributed the rash to the hay bedding and treated
with benadryl, and treated the cough with Nuflor (Florfenicol)
• October 12th, 2008 visited:– Comfort Texas (purchased 2 pigs)
• October 14th, 2008– Onset of clinical signs in 14 year old boy
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Travis CountyDSHS Central Office
Hale County
Pig Purchased
10/11/08
Bell County Case and S&W
Kendall County 2 pigs bought 10/12/08
You are here
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Texas Swine Influenza Case
• ‘Case pig owners’ contacted by TAHC on 11/4/2008
• Sick pig was purchased at ‘Ring of Success Pig Sale’ in Plainview Texas
• Pig was not consigned to the sale, but sold under private treaty off the trailer in the parking lot outside the sale
• Seller had ~60 pigs for sale • Pig was transported home on a trailer with several
other pigs originating from various sources and belonging to various owners– A third party hauler
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Investigation Participants
• Bell County HD– Angi Bridges,
• CDC– Lyn Finelli, Lenee Blanton, Steve Lindstrom, Tom Gomez et al
• DSHS– Martha Thompson and lab, Neil Pascoe, Russ Jones, others
• NVLS– Sabrina Swenson, Beverly Schmitt, others
• TAHC– Andy Schwartz, Tommy Barton, Dee Ellis, Matt Cochran, others
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Pandemic Influenza: When the Swine Flu Hits
the Fan?
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Influenza A
• Only flu A has subtypes
• 3 main subtypes have been identified with the majority of human disease (H1, H2, H3)
• Potential for tremendous genetic diversity
• Only flu A causes pandemics
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Human Influenza Taxonomy
• A (H1N1)/New Caledonia/20/99
• Type subtype Geographic strain year of
origin number isolation (often referred
to as strain)
Non human species will be described A(species)(H1N7)/Austin/325/2005
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Hemagglutinin
• Membrane protein that binds to cell surface receptors
• 16 different subtypes exist (1-16)
• Only H1, H2, and H3 have circulated in humans in the last century
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Neuraminidase
• 9 different subtypes (1-9)
• Responsible for penetration of epithelial cell wall- replication
• Only N1 and N2 have circulated in humans in the past century
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Antigenic Drift
• Only Flu A
• Responsible for yearly influenza activity
• Point mutations resulting after errors in RNA dependent RNA polymerase (3.6 x 10 –3 nucleotide changes/nucleotide site/year for hemagglutinin protein of influenza A as opposed to 1.6 in influenza B)
• Same subtype-H3N2 (Panama, Fujian, Korea)
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Antigenic Shift
• Results in novel subtype (H5N1, H9N2, H7N3)
• Responsible for pandemics
• Facilitated by segmented genome and large reservoir of different influenza A HA and NA subtypes in wild birds
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Pandemic Influenza
• Global outbreak of a new subtype of influenza to which virtually no one is immune– Novel subtype (strain)– Susceptible population– Virulent– Transmissible person to person
• Emergence of a novel strain can occur via:– Radical change in virus already infecting humans– Change in virus previously only seen in animals that
allows it to infect humans
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Recorded Influenza Pandemics
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USS Pandemic Flu
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First Case of Human Infection with SIV, San Diego, California
March 30: •10 year old male developed fever, cough, vomiting
•Seen in urgent care clinic
•NP swab collected
• April 13, 2009, CDC notified of 10 year old boy with respiratory illness from California
Unsubtypeable influenza A virus identified from specimen at clinic
April 14: Specimen received by CDC and swine influenza A (H1N1) virus identified
Public health laboratory testing for human influenza A subtypes was negative
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First Case of Human Infection with SIV, Imperial County,
California
March 28: • 9 year old female developed cough and fever
• Seen at clinic
•NP swab collected
• •April 17, 2009, CDC received unsubtypeable influenza A virus specimen from Naval Health Research Center (NHRC), San Diego
NHRC identified virus as unsubtypeable influenza A with possible swine origin
April 17:Specimen received by CDC and identified as swine influenza A (H1N1) virus
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Confirmed Cases of Human Infection with SIV
0
1
2
3
4
3/26
/200
9
3/29
/200
9
4/1/
2009
4/4/
2009
4/7/
2009
4/10
/200
9
4/13
/200
9
4/16
/200
9
Date
Texas Cases
California Cases
Num
ber
of C
onfir
med
Cas
es
Case Patient A Flew to Dallas,
Texas
No known epidemiologic link between the Texas and California cases
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Analysis of TexasConfirmed H1N1 Case Summary
As of 5/27/2009 at 10:00AM
The case summary is produced as analysis is complete. It may not include all cases and may not match CDC’s case numbers.
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Demographics*
Demographic N %Sex 846
– Male 412 49%– Female 434 51%
Age (median 10 yrs,
range 1 mos – 84 yrs)863
– <5 years 136 16%– 5-18 years 557 65%– 19-45 years 132 15%– >45 years 38 4%
*Based on confirmed cases for whom these data are available at time of report
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Additional Data on Confirmed Cases*
• Vaccinated within the last year for seasonal influenza– 34% (74 of 217) of children ≤18 years old– 26% (10 of 38) of people >18 years old
• 8% (21 of 274) with recent travel to Mexico
• 14 Cases were hospitalized (1 from Mexico)– 4 required ICU care– 6 deaths have been confirmed (as of 6/2/09)
*Based on confirmed cases for whom these data are available at time of report
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Signs and Symptoms
N Symptomatic
%
Fever (>100ºF)
(median temp: 102.0ºF)248 230 93%
Sore throat 283 169 60%Cough 313 272 87%GI symptoms (diarrhea and/or vomiting)
206 96 47%
Met Influenza Like Illness (ILI) case definition (fever and sore throat or cough)
216 187 87%
*Based on confirmed cases for whom these data are available at time of report
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Rapid Testing Data for Confirmed Cases as of 5/27/2009 10:00am
• Rapid flu test results available for 218 confirmed cases– 92% (201 of 218) positive for Flu A– 4% (9 of 218) positive flu undifferentiated– 4% (8 of 218) negative
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