Outbreak of Variant Influenza A(H3N2) Virus in the United States

Jhung, Michael A.; Epperson, Scott; Biggerstaff, Matthew; Allen, Donna; Balish, Amanda; Barnes, Nathelia; Beaudoin, Amanda; Berman, LaShondra; Bidol, Sally; Blanton, Lenee; Blythe, David; Brammer, Lynnette; D'Mello, Tiffany; Danila, Richard; Davis, William; de Fijter, Sietske; DiOrio, Mary; Durand, Lizette O.; Emery, Shannon; Fowler, Brian; Garten, Rebecca; Grant, Yoran; Greenbaum, Adena; Gubareva, Larisa; Havers, Fiona; Haupt, Thomas; House, Jennifer; Ibrahim, Sherif; Jiang, Victoria; Jain, Seema; Jernigan, Daniel; Kazmierczak, James; Klimov, Alexander; Lindstrom, Stephen; Longenberger, Allison; Lucas, Paul; Lynfield, Ruth; McMorrow, Meredith; Moll, Maria; Morin, Craig; Ostroff, Stephen; Page, Shannon L.; Park, Sarah Y.; Peters, Susan; Quinn, Celia; Reed, Carrie; Richards, Shawn; Scheftel, Joni; Simwale, Owen; Shu, Bo; Soyemi, Kenneth; Stauffer, Jill; Steffens, Craig; Su, Su; Torso, Lauren; Uyeki, Timothy M.; Vetter, Sara; Villanueva, Julie; Wong, Karen K.; Shaw, Michael; Bresee, Joseph S.; Cox, Nancy; Finelli, Lyn

Background. Variant influenza virus infections are rare but may have pandemic potential if person-to-person transmission is efficient. We describe the epidemiology of a multistate outbreak of an influenza A(H3N2) variant virus (H3N2v) first identified in 2011. Methods. We identified laboratory-confirmed cases of H3N2v and used a standard case report form to characterize illness and exposures. We considered illness to result from person-to-person H3N2v transmission if swine contact was not identified within 4 days prior to illness onset. Results. From 9 July to 7 September 2012, we identified 306 cases of H3N2v in 10 states. The median age of all patients was 7 years. Commonly reported signs and symptoms included fever (98%), cough (85%), and fatigue (83%). Sixteen patients (5.2%) were hospitalized, and 1 fatal case was identified. The majority of those infected reported agricultural fair attendance (93%) and/or contact with swine (95%) prior to illness. We identified 15 cases of possible person-to-person transmission of H3N2v. Viruses recovered from patients were 93%–100% identical and similar to viruses recovered from previous cases of H3N2v. All H3N2v viruses examined were susceptible to oseltamivir and zanamivir and resistant to adamantane antiviral medications. Conclusions. In a large outbreak of variant influenza, the majority of infected persons reported exposures, suggesting that swine contact at an agricultural fair was a risk for H3N2v infection. We identified limited person-to-person H3N2v virus transmission, but found no evidence of efficient or sustained person-to-person transmission. Fair managers and attendees should be aware of the risk of swine-to-human transmission of influenza viruses in these settings.