Swine Flu Questions and Info Part III

How serious is swine flu infection?

Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.

What is CDC doing in response to the outbreak?

April 29, 2009, 10:55 PM ETCDC has implemented its emergency response. The agency’s goals are to reduce transmission and illness severity, and provide information to help health care providers, public health officials and the public address the challenges posed by the new virus. CDC continues to issue new interim guidance for clinicians and public health professionals. In addition, CDC’s Division of the Strategic National Stockpile (SNS) continues to send antiviral drugs, personal protective equipment, and respiratory protection devices to all 50 states and U.S. territories to help them respond to the outbreak.

What epidemiological investigations are taking place in response to the recent outbreak?

CDC works very closely with state and local officials in areas where human cases of H1N1 (swine flu) infections have been identified. In California and Texas, where EpiAid teams have been deployed, many epidemiological activities are taking place or planned including:

• Active surveillance in the counties where infections in humans have been identified;
• Studies of health care workers who were exposed to patients infected with the virus to see if they became infected;
• Studies of households and other contacts of people who were confirmed to have been infected to see if they became infected;
• Study of a public high school where three confirmed human cases of influenza A (H1N1) of swine origin occurred to see if anyone became infected and how much contact they had with a confirmed case; and
• Study to see how long a person with the virus infection sheds the virus.

Source: http://www.cdc.gov/swineflu/swineflu_you.htm

For previous Part II of this series go to http://moldandasbestos.blogspot.com/2009/04/swine-flu-questions-part-ii.html

Agricultural Workers At Increased Risk For Infection With Animal Flu Viruses

Findings May Have Implications for Pandemic Flu Planning

(EPA press release - http://www.epa.gov/aging/press/othernews/2005/2005_1125_ons_1.htm )

Farmers, veterinarians and meat processors who routinely come into contact with pigs in their jobs have a markedly increased risk of infection with flu viruses that infect pigs, according to a study funded in part by the National Institute of Allergy and Infectious Diseases (NIAID), one of the National Institutes of Health (NIH). While the findings are not entirely unexpected, the strikingly higher risk of infection coupled with the fact that pigs can be infected by swine viruses, bird (avian) viruses as well as human flu viruses -- thereby acting as a virtual virus "mixing bowl," especially on farms where pigs, chickens and people coexist -- is a potential public health concern, the study authors assert. The paper appears online this week in "Clinical Infectious Diseases".

"Pigs play a role in transmitting influenza virus to humans," says NIAID Director Anthony S. Fauci, M.D. "The worry is that if a pig were to become simultaneously infected with both a human and an avian influenza virus, genes from these viruses could reassemble into a new virus that could be transmitted to and cause disease in people."

The study results strongly suggest that occupational exposure to pigs significantly increases the risk of developing swine influenza infection. Agricultural workers should, therefore, be considered in developing flu pandemic surveillance plans and antiviral and immunization strategies, according to the study's co-investigator, Gregory C. Gray, M.D., director of the University of Iowa Center for Emerging Infectious Diseases.

"If migratory birds introduce the H5N1 bird flu virus into swine or poultry populations in this country, agricultural workers may be at a much greater risk of developing a variant H5N1 and passing it along to non-agricultural workers," Gray says. "Not protecting agricultural workers could amplify influenza transmission among humans and domestic animals during a pandemic and cause considerable damage to the swine and poultry industries, as well as the U.S. economy." While swine in other countries have been infected by the H5N1 virus, to date, the virus has not become readily transmissible between swine.

Swine influenza infections generally produce mild or no symptoms in both pigs and humans. However, exposure to swine flu virus at a 1988 Wisconsin county fair resulted in serious illness for 50 swine exhibitors and three of their family members; one previously healthy woman who became infected died.

The U.S. swine industry, which employs about 575,000 people, has shifted during the past 60 years from primarily small herds located on family farms to large herds maintained in expansive but confined agricultural facilities. Crowded conditions coupled with the constant introduction of young pigs to existing herds have made swine flu infections among pigs a year-round occurrence rather than the seasonal event they once were. As a result, there is a constant opportunity for people who are occupationally exposed to pigs to become infected with influenza viruses and, conversely, a continual opportunity for human flu viruses to mix with swine or bird flu viruses.
To determine the prevalence of swine influenza infection among swine-exposed employees, the researchers, led by Dr. Gray and graduate student Kendall P. Myers, examined serum samples taken from four adult populations in Iowa between 2002 and 2004. Three populations were occupational groups exposed to pigs: 111 farmers, 97 meat processing workers and 65 veterinarians. The fourth control group included 79 volunteers from the University of Iowa with no occupational pig exposure.

The researchers tested the serum samples for antibodies to several then-current swine and human influenza A viruses. The results showed that all three occupational study groups had markedly elevated antibodies to swine flu viruses compared with the control group. Farmers had the strongest indication of exposure to swine flu viruses, as much as 35 times higher than the control group. Similarly, comparable values were as much as 18 times higher for veterinarians and as much as 7 times higher for meat processors than the control group. In contrast, exposure to human flu virus in the occupational groups was not significantly different than that of the control group.

To date, the H5N1 avian virus has not appeared in the United States in any animal population or in humans.

NIAID is a component of the National Institutes of Health, an agency of the U.S. Department of Health and Human Services. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism. NIAID also supports research on transplantation and immune-related illnesses, including autoimmune disorders, asthma and allergies.

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References: KP Myers et al. Are swine workers in the United States at increased risk of infection with zoonotic influenza virus? "Clinical Infectious Diseases". Published online November 22, 2005. Appearing in the January 1, 2006 print edition.

News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at http://www.niaid.nih.gov.

The National Institutes of Health (NIH) -- "The Nation's Medical Research Agency" -- includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

This NIH News Release is available online at: http://www.nih.gov/news/pr/nov2005/niaid-25.htm

Avian Flu (Avian Influenza) Viruses Introduction Information

As per the United States OSHA website, numerous stories have aired on radio and television or been published in various news media concerning avian influenza and in particular the H5N1 subtype. Unfortunately there is now much confusion about the different human diseases caused by influenza viruses.

Influenza A viruses can cause three distinct diseases in humans: avian, pandemic and seasonal influenza. Avian influenza in humans is rare and the most common route of infection is via direct or indirect contact with secretions (nasal, oral or fecal) from infected poultry. Transmission from human-to-human, if it exists, is extremely rare. However, avian influenza viruses have the potential to mutate or reassort and become pandemic viruses; those that can be readily transmitted between humans and those for which the population has little immunity. If these viruses spread throughout the world, the disease caused by them would be called pandemic influenza and the new viruses would be called pandemic influenza viruses. Previous pandemic influenza episodes have occurred in two or three waves of 6-8 week duration and spanned a 12-18 month period. After this period, the population will have built up immunity to the virus, either naturally or through vaccination. If the virus continues to circulate in the population and causes disease, it would become an influenza virus that causes seasonal influenza (more popularly called human influenza or the flu).

Influenza A viruses are subdivided into numerous subtypes. The subtypes are differentiated by variations in two viral surface proteins, hemagglutinin (H) and neuraminidase (N). Sixteen different H proteins and nine N proteins have been identified. Subtypes are designated by numbering particular combinations of these proteins (e.g., H5N1). Therefore, there are a total of 144 possible subtypes (16H x 9N) of influenza A viruses and all or most of these have been found in wild waterfowl. Interestingly only three of the 144 subtypes, H1N1, H2N2 and H3N2, have caused pandemic influenza in the 20th century. Only strains of H1N1 and H3N2 are currently circulating and causing seasonal influenza. Recently a number of different subtypes of influenza A viruses have emerged as agents of avian influenza in humans and these include H5N1, H7N2, H7N3, H7N7 and H9N2.

As of October 2006, H5N1 viruses have killed more than 150 people in ten different countries since the beginning of 2003. On the other hand, the H7N7 virus has been associated with a single human death but numerous cases of conjunctivitis (eye infection) in the Netherlands. The H7N2, H7N3 and H9N2 viruses have caused only mild disease in humans. While the number of human deaths caused by the H5N1 virus is small in comparison to the annual deaths attributed to human seasonal influenza viruses (~36,000/ year in the U.S.), it is of particular concern to the public health community because many scientists believe that this virus may continue to mutate or reassort and a strain may ultimately develop the ability to pass readily between humans. If this happens, the virus that emerges may cause the next major influenza pandemic.

As of October 2006, the highly pathogenic avian influenza (HPAI) H5N1 virus has not been detected in North or South America and it is important to understand that a pandemic influenza virus has not yet emerged and when, and if, it will emerge is impossible to predict.

For more information visit the OSHA website



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OSHA Guidance Update on Protecting Employees from Avian Flu (Avian Influenza) Viruses

OSHA Guidance Update on Protecting Employeesfrom Avian Flu (Avian Influenza) Viruses

Employers are responsible for providing a safe and healthful workplace for their employees. OSHA's role is to assure the safety and health of America's employees by setting and enforcing standards; providing training, outreach and education; establishing partnerships; and encouraging continual improvement in workplace safety and health.

The handbook provides a general overview of a particular topic related to OSHA standards. It does not alter or determine compliance responsibilities in OSHA standards or the Occupational Safety and Health Act of 1970. Because interpretations and enforcement policy may change over time, you should consult current OSHA administrative interpretations and decisions by the Occupational Safety and Health Review Commission and the Courts for additional guidance on OSHA compliance requirements.

To see the entire publication go to
http://www.osha.gov/Publications/3323-10N-2006-English-07-17-2007.html