W5-1030-Pascoe-SwineFluTexas

Document Sample
W5-1030-Pascoe-SwineFluTexas Powered By Docstoc
					Not Yet….
Novel Human Swine Flu Event
        Texas 2008
        Neil Pascoe
           DSHS
        Matt Cochran
           TAHC
             Program

• Swine flu investigation 2008
• Discuss Pandemic Influenza
• Novel H1N1-2009 (Swine Flu)
But first a
message from
our sponsor
Texas Human Swine Influenza
          Case
 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
                     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)
                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
             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.)
  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
                         You are here
  Hale County
  Pig Purchased
  10/11/08




Kendall
County 2 pigs
bought
10/12/08


         Travis County
                         Bell County
         DSHS Central
                         Case and S&W
         Office
   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
       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
Pandemic Influenza:
When the Swine Flu Hits
    the Fan?
         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
    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
           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
          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
             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)
            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
           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
Recorded Influenza Pandemics
    First Case of Human Infection
    with SIV, San Diego, California
     • April 13, 2009, CDC notified of 10 year old boy with
     respiratory illness from California


March 30:
•10 year old
male developed    Unsubtypeable        Public health        April 14:
fever, cough,     influenza A virus    laboratory testing   Specimen received by
vomiting          identified from      for human            CDC and swine
                  specimen at clinic   influenza A          influenza A (H1N1)
•Seen in urgent                        subtypes was         virus identified
care clinic                            negative

•NP swab
collected
 First Case of Human Infection
   with SIV, Imperial County,
•          California
•April 17, 2009, CDC received unsubtypeable influenza A
virus specimen from Naval Health Research Center
(NHRC), San Diego

     March 28:
     • 9 year old
     female
     developed          NHRC identified    April 17:
     cough and fever    virus as           Specimen received by
                        unsubtypeable      CDC and identified as
     • Seen at clinic   influenza A with   swine influenza A
                        possible swine     (H1N1) virus
     •NP swab           origin
     collected
                            Confirmed Cases of Human
                            4
                                 Infection with SIV
                                No known epidemiologic
Number of Confirmed Cases




                                link between the Texas and      Texas Cases
                            3   California cases                California Cases
                                           Case Patient A
                                           Flew to Dallas,
                            2
                                               Texas


                            1


                            0
                                       9


                                       9




                                       9


                                       9


                                       9
                                     09


                                     09


                                     09
                                    00


                                    00




                                    00


                                    00


                                    00
                                  20


                                  20


                                  20
                                 /2


                                 /2




                                 /2


                                 /2


                                 /2
                               1/


                               4/


                               7/
                              26


                              29




                              10


                              13


                              16
                             4/


                             4/


                             4/
                            3/


                            3/




                            4/


                            4/


                            4/
                                                         Date
       Analysis of Texas
Confirmed 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.
                                        Demographics*

        Demographic                                             N               %
        Sex                                                    846
           – Male                                              412              49%
           – Female                                            434              51%
        Age (median 10 yrs,
                                                               863
          range 1 mos – 84 yrs)
           – <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
           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
                              Signs and Symptoms

                                                         N         Symptomati   %
                                                                       c
        Fever (>100ºF)
                                                        248               230   93%
        (median temp: 102.0ºF)
        Sore throat                                     283               169   60%
        Cough                                           313               272   87%
        GI symptoms (diarrhea
                                                        206                96   47%
        and/or vomiting)
        Met Influenza Like Illness
        (ILI) case definition (fever                    216               187   87%
        and sore throat or cough)
*Based on confirmed cases for whom these data are available at time of report
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

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:3
posted:7/29/2012
language:
pages:42