Twelve Swine Flu Cases Reported In Five States, Says CDC, USA


The CDC informs that it has received twelve reports of humans infected with swine flu - A(H3N2) virus. Reported cases have come in from West Virginia, Pennsylvania, Maine, Iowa, and Indiana. Eleven of them were children. Half of all the cases had not been exposed to swine, the CDC (Centers for Disease Control and Prevention) adds. All patients have made a full recovery; three had to be admitted to hospital.

One of the patients, an adult male, had been exposed to swine through his job.

more at link

http://www.medicalnewstoday.com/articles/239707.php


A sample of mucus taken from the patient came back positive for influenza, according to a hospital pathologist. The virus was identified by rRT-PCR (real-time, reverse transcription-polymerase chain reaction) as an inconclusive influenza A virus by the Indiana Public Health Laboratory. This is consistent with other A(H3N2)v infection lab results. The genome sequencing was confirmed by the CDC on October 30th as being of an "A(H3N2)v virus with the M gene from the A(H1N1)pdm09 virus" - this is similar to the ones detected in other human infections in the USA in 2011 (August).



This is the new mutated version which is circulating

INFLUENZA (78): UNITED STATES OF AMERICA, SWINE-ORIGIN H3N2
REASSORTANTS UPDATE
********************************************************************************

A ProMED-mail post
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International Society for Infectious Diseases
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[1]Date: Fri 23 Dec 2011Source: Brandon Sun, The Canadian Press [edited]http://www.brandonsun.com/lifestyles/breaking-news/us-finds-new-human-infection-with-swine-h3n2-flu-virus-now-called-variant-136160753.html?thx=y


U.S. finds new human infection with swine H3N2 flu; virus now called
‘variant’
-----------------------------------------------------------------
U.S. public health officials have found another case of human
infection with a swine-origin H3N2 virus, this time in a child from
West Virginia. And they also reported finding a human infection with a
new swine influenza virus never before seen in humans, in a person in
Wisconsin who had contact with pigs. The Wisconsin case seems to be a
one-off infection, with no signs of further spread. But the
investigation into the West Virginia case suggests the child was
infected by another person, not a pig and that some amount of
human-to-human spread of the virus took place in the unnamed community
where the child lives, according to details released Friday by the
U.S. Centers for Disease Control [see below - Mod.CP].

The H3N2 case is the 12th – in five states -- reported in the U.S.
since this new virus was first spotted in July. And the CD
acknowledges there are probably more cases that haven’t been picked
up by the country’s flu surveillance systems. "We don’t think
these are all" the cases, said Dr. Joe Bresee, head of the influenza
epidemiology team in the CDC's Influenza division. To date no other
country has reported seeing human infections with this virus, which
has also been isolated from pigs in the U.S.

Details of the investigations into the West Virginia case -- the
second in that state -- and one spotted in the fall in Indiana were
released late Friday [23 Dec 2011]. The Indiana case was in a man who
worked with pigs. A separate release revealed details of the Wisconsin
case, which involved a new H1N1 virus with genes from avian, swine and
human flu viruses. The case accounts were contained in a report that
revealed that international influenza science partners have agreed to
a new name for these viruses, one that drops the constant reference to
the viruses’ swine origin. The agricultural sector objected loudly
in the early days of the 2009 pandemic when human health officials
referred to the new virus as a swine influenza virus. Pork sales
plummeted and the industry has been worried the same could happen
again with new reports of human infections with swine flu viruses. The
World Health Organization and the UN’s Food and Agriculture
Organization have agreed to call these viruses "H3N2 variants" or
H3N2v for short. The new H1N1 virus -- which has been circulating in
pigs since last year -- will be similarly called H1N1v.

The H3N2v viruses are hybrids of a swine influenza virus that has been
circulating for more than a decade in pigs. That virus has acquired an
internal gene -- the M gene -- from the H1N1 virus that caused the
2009 pandemic. Studies have shown that gene appears to make viruses
that contain it more transmissible among guinea pigs, a model that is
used to predict how flu behaves in humans. The virus from the H1N1v
case in Wisconsin also contains the M gene from the 2009 pandemic
virus.

http://www.promedmail.org/?p=2400:1000: ... 702832:::::

also from the above release



This H3N2v virus is a distant cousin of the virus by the same name
that circulates among humans. Testing conducted at the CDC suggests
the virus is most closely related to human H3N2 viruses that
circulated in the early 1990s, which suggests many people over age 20
may have some antibodies that would respond to the variant virus.

-----


If it appeared the viruses were causing enough disease
to warrant including them in the annual flu strain "that will be a
mess," said Adolfo Garcia-Sastre, an influenza researcher at New
York’s Mount Sinai Hospital. "If they jump into humans, I don’t
think it will be a big public health nightmare," Garcia-Sastre said.
"But I think what it could do is it may be able to establish a second
lineage of H3s. And that will make it very difficult to handle, from
the point of view of the vaccine."



trying to figure out the wording above..does he mean this years vaccine or future vaccines

Editorial Note
Human infections with the influenza viruses currently circulating among swine are rare. Since 2005, only 35 cases have been reported in the United States, but the frequency with which they have been detected increased in 2011. When different influenza viruses simultaneously infect a single host (e.g., a human or swine), exchange of genetic material can occur, resulting in a new influenza virus. Depending on the antigenic distance between the new virus and recently circulating seasonal viruses, little or no immunity might exist in the human population. Influenza A (H3N2)v viruses resulted from reassortment of influenza A (H1N1)pdm09 viruses with swine influenza A (H3N2) viruses. A diagram depicting this reassortment is available online from CDC's Public Health Image Library.§ Because these viruses carry a newly identified combination of genes, little information is available regarding transmission efficiency in swine, in humans, or between swine and humans. However, the recent human cases involving swine exposure and results of SIV surveillance indicate that these viruses also currently are circulating in swine herds.

The case of influenza A (H3N2)v infection after occupational contact with swine in Indiana and the apparent limited human-to-human transmission of A(H3N2)v virus that occurred in a day care setting in West Virginia represent two different possible scenarios for transmission of this virus. Work exposure highlights the risk for interspecies influenza transmission in occupational settings where humans are exposed to swine, an association that has been described previously (3–7). To minimize the risk for interspecies influenza transmission in occupational settings, CDC and the Occupational Safety and Health Administration (OSHA) encourage swine workers to 1) get vaccinated against human seasonal influenza, 2) wear appropriate PPE, and 3) practice good hygiene, such as washing hands thoroughly with soap and water, when in contact with swine, especially swine that show signs of illness. The National Pork Board also recommends producers work with their veterinarian to develop appropriate prevention and control measures for influenza in swine, which can include vaccinating swine against swine influenza. Similar to humans, swine infected with influenza viruses do not always exhibit signs of infection (8). Persons with swine exposure in the week before onset of an illness with symptoms of influenza requiring medical care should notify their health-care provider of their swine exposures. Persons who develop symptoms of influenza after close contact with swine are recommended to stay home until well to minimize contact with persons and swine as much as possible.

Guidance materials for persons who work with swine have been published by OSHA.¶ In addition, the National Pork Board,** CDC, and the National Association of State Public Health Veterinarians have published guidance for persons exposed to swine in public settings (9). Clinicians should consider variant influenza virus infection in the differential diagnosis of patients with febrile respiratory illness who have been near swine whether at work or at an agricultural event, such as a fair or exhibit.

The A(H3N2)v cases in West Virginia involved two children who attended the same day care, but the first child was unlikely to have transmitted the virus to the second child, given the ≥10-day difference in their symptom onset dates. This represents a scenario of limited human-to-human transmission occurring in a day care setting. Therefore, clinicians also should consider the possibility of influenza A (H3N2)v infections in patients who have not had exposure to swine, particularly young children in those states where influenza A (H3N2)v cases have been reported. Clinicians who suspect variant influenza virus infection should obtain a nasopharyngeal swab, place the swab in viral transport medium, and contact their state or local health department to facilitate transport and timely diagnosis (10). Influenza A (H3N2)v viruses detected to date are susceptible to oseltamivir and zanamivir for the treatment of influenza. Clinicians who suspect variant influenza infection in a patient should consider treatment with these medications if clinically indicated (10). Because these viruses have the M gene from the influenza A (H1N1)pdm09 virus, they are resistant to amantadine and rimantadine. CDC requests that state public health laboratories notify CDC immediately of suspected variant influenza A specimens and send them to the CDC Influenza Division's Virus Surveillance and Diagnostics Branch Laboratory. Confirmed cases should be investigated thoroughly and expeditiously to ascertain whether swine-to-human or human-to-human transmission is ongoing and to limit further exposures between humans with others and swine. Such investigations require close collaboration among state, local, and federal public and animal health officials.

CDC is working with USDA and state public health and animal health experts in the locations where these cases have occurred to investigate each case fully and to enhance influenza surveillance to detect human cases of variant influenza virus infections. The CDC rRT-PCR assay that was approved by the Food and Drug Administration in September 2011 is able to identify these cases as presumptive influenza A (H3N2)v cases. These diagnostic test kits have been distributed to public health laboratories in the United States and National Influenza Centers designated by the World Health Organization in other countries. Additional rRT-PCR test enhancements to further improve detection of influenza A (H3N2)v viruses are under development.

Limited serologic studies conducted to date indicate that young children have little preexisting immunity to influenza A (H3N2)v viruses. Because the hemagglutinin genes of these viruses are related to human influenza A (H3N2) viruses that circulated in the 1990s, older children and adults might have limited immunity against these viruses. Certain persons, including young children, pregnant women, persons with chronic health conditions such as asthma, diabetes, or heart and lung disease, and persons aged ≥65 years, are likely to be at greater risk for serious influenza-related complications from variant influenza viruses such as influenza A (H3N2)v. The influenza A (H3N2)v virus is different enough from current human seasonal influenza viruses that the seasonal influenza vaccine is not expected to provide significant protection.

CDC will provide routine and timely communications regarding these influenza A (H3N2)v viruses and other variant influenza viruses with the public, partners, state and local health departments, and stakeholders. Updated information and guidance documents related to A(H3N2)v viruses are available online from CDC at http://www.cdc.gov/flu/swineflu/influen ... iruses.htm.

http://www.cdc.gov/mmwr/preview/mmwrhtm ... 1223a1.htm

This is the new terminolgy for this flu variant according to WHO



Standardization of terminology for the variant
A(H3N2) virus recently infecting humans

Joint announcement of FAO, OIE and WHO

23 December 2011

FAO, OIE and WHO continue working closely together to address influenza issues related to public health and animal health.

Since July 2011, twelve human cases of infection with a variant influenza A(H3N2) virus have been detected in the United States. To date, no report has been received from elsewhere in the world. This virus has different virological characteristics from current circulating seasonal influenza viruses in humans, and has a new gene constellation: 7 genes from the triple reassortant A(H3N2) viruses known to have been circulating in pigs in the North America and the M gene from an A(H1N1)pdm09 virus, a seasonal virus currently circulating in humans.

In order to improve communications and avoid confusion, FAO, OIE and WHO have established a working group of experts to standardize the terminology for variant influenza viruses. The joint recommendation for the above mentioned A(H3N2) virus is: A(H3N2)v , where “v” stands for “variant”.

An example of use of the terminology:

Sporadic human cases of infection with a variant influenza A(H3N2) virus A(H3N2)v have been reported in the USA. The A(H3N2)v virus is different from seasonal viruses currently circulating in humans.


http://www.who.int/influenza/gisrs_labo ... index.html

CDC: US Swine Flu Infections Rare, Rose in 2011

Human infections with the flu circulating in swine are rare but increased this year, leading to the hospitalization of three people who recovered, the Centers for Disease Control and Prevention said Friday.

Since 2005, 35 cases have been reported in the United States but their frequency rose in 2011.


http://www.medicaldaily.com/news/201112 ... rginia.htm

Implications for diagnostics

The sequence analysis of the other gene segments like M, NP or NA also provided information on the capability of molecular diagnostic procedures to detect the S-Otr H3N2 virus. These viruses acquired the M gene segment from the human influenza A(H1N1)pdm09 virus. This implies that the generic detection through RT-PCR targeting the M gene will have very good sensitivity also for the S-Otr viruses. However, depending on possible mismatches in the primers and/or probes, the RT-PCR targeting the HA or NA gene segments may either be lacking sensitivity or possibly fail to detect the S-Otr H3N2 virus. Conversely, in terms of alertness and surveillance, the use of H3 and/or N2 subtyping RT-PCRs that would have equal sensitivity for seasonal human and swine-origin H3N2 viruses, should not be promoted at this stage because these procedures may fail to recognise cases of S-Otr H3N2 virus infection. Hence, for accurate detection and surveillance, specific RT-PCR methods should be developed, or alternatively, predefined algorithms with already existing discriminating molecular tools need to be implemented [9]. Lastly, the NA and M2 sequences available from the recent isolates suggest that, as for the influenza A(H1N1)pdm09 virus, antiviral drugs that block the M2 ion channel will not be effective because the M2 sequence carries the S31N mutation associated with resistance. No known genetic markers for resistance to NA inhibitors have been detected in these new strains so far. This should be confirmed by phenotypic assays.

Implications for immunological cross-protection

In case of the emergence of a zoonotic virus with an HA derived from previously circulating human viruses, it needs to be established whether or not infections with human influenza viruses in the past seasons or vaccinations confer cross-protection against the new viruses. Indeed, during the recent pandemic in 2009, it was observed that upon infection or vaccination of elderly people previously exposed to influenza A(H1N1) viruses that shared common epitopes with the emerging pandemic virus, efficient cross-protection was induced through memory immune cells [10]. The comparison of the five antigenic domains of past influenza A(H3N2) human viruses with those of the S-Otr viruses showed similarities and differences. Hence, it is impossible to predict if pre-existing immunity will be efficient against this virus, even if it seems likely that some cross-protection will exist; seroepidemiological surveys should be carried out to support or disprove this hypothesis. One must also keep in mind that if there is pre-existing immunity to this virus, it may occur in different age groups than observed with the influenza A(H1N1)pdm09 virus.

Conclusion

Overall, even if neither the evolution of these S-Otr H3N2 viruses nor their putative impact in the general population can be predicted enhanced surveillance with adapted diagnostic procedures will become necessary if these sporadic cases turn into sustained dissemination. According to the similarities observed between the sequences of the S-Otr and human H3 influenza viruses (especially those circulating before 1995), the likelihood of cross-protection is high, but should be confirmed with seroepidemiological studies.

http://www.eurosurveillance.org/ViewArt ... leId=20039

WHO gearing up response to puzzling new flu virus

The spread of an odd new flu virus that has been jumping from pigs to people in parts of the United States has the World Health Organization gearing up its response planning, a senior official of the agency says.

The UN health body is figuring out what needs to be done if the virus continues to spread and a global response is required, Dr. Keiji Fukuda, assistant director-general for health security and environment said in an interview from Geneva.

The WHO wants to be ready to make recommendations and issue guidance to countries if the need arises -- though Fukuda stressed at this point it is far from certain there will be that need.

"We're very aware that we don't want to over-play or under-play. We're trying to get that right," says Fukuda, a leading influenza expert.

"(We're) trying to make sure that we're ready to move quickly, if we have to move quickly, but also trying not to raise alarm bells."

The desire to be prepared without raising alarm is a legacy of the 2009 H1N1 pandemic. The WHO was heavily criticized in Europe for declaring that event a pandemic when the outbreak turned out to be far milder than originally feared.

But what exactly the agency -- and the world -- might need to prepare for now is very unclear. With the public relations problems of the 2009 outbreak fresh in the minds of health officials, no one is using the "p" word these days.

Yet in some respects the parallels to 2009 are striking.

A new swine-origin flu virus is causing sporadic infections in parts of the United States. Since the new virus was first spotted in July, 10 cases have been confirmed in Maine, Indiana, Pennsylvania and Iowa. All have been children under 10, with a lone exception -- a 58-year-old adult. Three of the cases have required hospitalization but most of the infections have been mild, like regular flu.

It is an influenza A virus of the H3N2 subtype, a distant cousin of H3N2 viruses that circulate in humans.



Read more: http://www.ctv.ca/CTVNews/TopStories/20 ... z1hdSVC7l0

U.S. finds new human infection with swine H3N2 flu; virus now called ‘variant’

U.S. public health officials have found another case of human infection with a swine-origin H3N2 virus, this time in a child from West Virginia. And they also reported finding a human infection with a new swine influenza virus never before seen in humans, in a person in Wisconsin who had contact with pigs.

The Wisconsin case seems to be a one-off infection, with no signs of further spread. But the investigation into West Virginia case suggests the child was infected by another person, not a pig and that some amount of human-to-human spread of the virus took place in the unnamed community where the child lives, according to details released Friday by the U.S. Centers for Disease Control.

The H3N2 case is the 12th – in five states – reported in the U.S. since this new virus was first spotted in July. And the CDC acknowledges there are probably more cases that haven’t been picked up by the country’s flu surveillance systems.

"We don’t think these are all" the cases, said Dr. Joe Bresee, head of the influenza epidemiology team in the CDC’s Influenza division.

To date no other country has reported seeing human infections with this virus, which has also been isolated from pigs in the U.S.

Details of the investigations into the West Virginia case -- the second in that state -- and one spotted in the fall in Indiana were released late Friday. The Indiana case was in a man who worked with pigs. A separate release revealed details of the Wisconsin case, which involved a new H1N1 virus with genes from avian, swine and human flu viruses.

The case accounts were contained in a report that revealed that international influenza science partners have agreed to a new name for these viruses, one that drops the constant reference to the viruses’ swine origin.

The agricultural sector objected loudly in the early days of the 2009 pandemic when human health officials referred to the new virus as a swine influenza virus. Pork sales plummeted and the industry has been worried the same could happen again with new reports of human infections with swine flu viruses.

The World Health Organization and the UN’s Food and Agriculture Organization have agreed to call these viruses "H3N2 variants" or H3N2v for short. The new H1N1 virus -- which has been circulating in pigs since last year -- will be similarly called H1N1v.

http://www.brandonsun.com/lifestyles/br ... html?thx=y

Pandemic Flu Planning Checklist
When it comes to pandemic flu, it can never be too early to plan ahead for your personal health and safety. The following checklist can help individuals and families to prepare for a possible flu pandemic or other emergency situations.

Create a store of emergency supplies

In the event of a flu pandemic, some day-to-day services may be disrupted including those provided by health care facilities, banks, stores (e.g. grocery stores and pharmacies), restaurants and government offices. Stockpiling essential supplies for you and your family is a good way to prepare for this possibility. The following list provides examples of non-perishable food items, health supplies and other items you should have in your home in the event of a flu pandemic.

Food and Water

Health Supplies

Other

Bottled water - at least two liters of water per person per day

Ready-to-eat canned meats

Canned fruit

Dried fruit

Canned vegetables

Soup

Protein bars

Dry cereal/granola

Peanut butter/nuts

Crackers

Canned juices

Tetra-packed milk or soy beverage

If applicable:

Canned or jarred baby food/formula

Pet food and water

Pain relievers/fever reducers (e.g. acetaminophen, ibuprofen)

Stomach remedies

Cough and cold medicine

Anti-diarrhea medication

Fluids with salt and sugar

Vitamins

Prescribed medical supplies

such as glucose and blood-pressure

monitoring equipment

Thermometer

Equipment for persons with disabilities

Soap

Alcohol-based hand sanitizer

Flashlight

Batteries

Battery powered or wind-up radio

Manual can opener

Garbage bags

Tissues

Toilet paper

Candles and matches or lighter

General first aid kit

Extra keys for car and house

Cash and change for payphones

If applicable:

Feminine hygiene products

Disposable diapers

Diaper wipes (in the event of a water shortage)

Quick Tips

Keep prescription medications filled. If you or anyone else in your household takes prescription medication, don't wait until it is finished to order more. Try to keep at least one month's supply on hand at all times.
Discuss care options with family members and other loved ones. If you will be bringing others into your home to care for them in the event of a flu pandemic, discuss what health supplies, special foods or other items they require. Add those items to your emergency supply list.
Fill out an Emergency Health Information sheet. Include blood type, allergies, pre-existing medical conditions and a list of current medications (type and dose) for each member of your household.


http://www.phac-aspc.gc.ca/influenza/fam-pl-ckl-eng.php

EpiPen cap warning issued by distributor


Taking the cap off an EpiPen incorrectly when treating a severe food allergy could potentially result in failure to deliver the drug, the distributor of the device says.

Health Canada said Friday that Pfizer Canada, distributor of the EpiPen and EpiPen Jr autoinjectors, says the blue safety cap on the device should be removed by pulling the cap straight up while holding the orange tip downward

http://www.cbc.ca/news/health/story/201 ... y-ana.html

Higher Arsenic Levels Found in Those Who Eat More Rice

People who eat more rice have higher levels of arsenic in their systems, a new study finds. The findings suggest eating rice may expose some people to potentially harmful levels of arsenic.

The study, which was conducted in pregnant women, found that consuming just over one-half of a cup of cooked rice is equivalent to drinking 34 ounces (one liter) of water containing maximum amount of arsenic allowed by the federal limit (10 parts per billion).

The findings suggest some cultural groups may have higher arsenic exposures through rice than others, the researchers say. The average American eats about one-half of a cup of cooked rice per day, while consumption among Asian Americans exceeds two cups per day, the researchers said.

The findings come shortly after the release of test results by Consumer Reports showing potentially unsafe levels of arsenic in apple juice. The results also cited concerns over arsenic levels in rice, particularly the rice in infant cereals.

For people in the United States and Europe, rice is the largest dietary source of inorganic arsenic, said Andrew Meharg, chair of biogeochemistry at the University of Aberdeen in Scotland.

Chronic exposure to low levels of inorganic arsenic has been linked to increased risks of bladder,lung and skin cancer, as well as Type 2 diabetes and cardiovascular disease, according to the Environmental Protection Agency.

However, it's not yet clear whether the arsenic in rice, juice or other foods is harmful to people.
More research is needed to determine the health impact of exposure to arsenic in rice, the researchers say, but in any case, exposure in pregnant women is particularly concerning because of the potential risk to the unborn fetus.


Read more: http://www.foxnews.com/health/2011/12/0 ... z1hdWlcWlr