Outbreak of Variant Influenza A(H3N2) Virus in the United States
Identifieur interne : 000166 ( PascalFrancis/Corpus ); précédent : 000165; suivant : 000167Outbreak of Variant Influenza A(H3N2) Virus in the United States
Auteurs : Michael A. Jhung ; Scott Epperson ; Matthew Biggerstaff ; Donna Allen ; Amanda Balish ; Nathelia Barnes ; Amanda Beaudoin ; Lashondra Berman ; Sally Bidol ; Lenee Blanton ; David Blythe ; Lynnette Brammer ; Tiffany D'Mello ; Richard Danila ; William Davis ; Sietske De Fijter ; Mary Diorio ; Lizette O. Durand ; Shannon Emery ; Brian Fowler ; Rebecca Garten ; Yoran Grant ; Adena Greenbaum ; Larisa Gubareva ; Fiona Havers ; Thomas Haupt ; Jennifer House ; Sherif Ibrahim ; Victoria Jiang ; Seema Jain ; Daniel Jernigan ; James Kazmierczak ; Alexander Klimov ; Stephen Lindstrom ; Allison Longenberger ; Paul Lucas ; Ruth Lynfield ; Meredith Mcmorrow ; Maria Moll ; Craig Morin ; Stephen Ostroff ; Shannon L. Page ; Sarah Y. Park ; Susan Peters ; Celia Quinn ; Carrie Reed ; Shawn Richards ; Joni Scheftel ; Owen Simwale ; BO SHU ; Kenneth Soyemi ; Jill Stauffer ; Craig Steffens ; SU SU ; Lauren Torso ; Timothy M. Uyeki ; Sara Vetter ; Julie Villanueva ; Karen K. Wong ; Michael ShawSource :
- Clinical infectious diseases [ 1058-4838 ] ; 2013.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
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 oselta-mivir 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.
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Format Inist (serveur)
NO : | PASCAL 14-0017918 INIST |
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ET : | Outbreak of Variant Influenza A(H3N2) Virus in the United States |
AU : | 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); BO SHU; SOYEMI (Kenneth); STAUFFER (Jill); STEFFENS (Craig); SU SU; TORSO (Lauren); UYEKI (Timothy M.); VETTER (Sara); VILLANUEVA (Julie); WONG (Karen K.); SHAW (Michael) |
AF : | Influenza Division, National Center for Immunization and Respiratory Disease/Etats-Unis (1 aut., 2 aut., 3 aut., 5 aut., 6 aut., 8 aut., 10 aut., 12 aut., 13 aut., 15 aut., 19 aut., 21 aut., 24 aut., 29 aut., 30 aut., 31 aut., 33 aut., 34 aut., 38 aut., 46 aut.); Epidemic Intelligence Service assigned to the Influenza Division, Centers for Disease Control and Prevention/Atlanta, Georgia/Etats-Unis (18 aut., 23 aut., 25 aut., 59 aut.); Epidemic Intelligence Service assigned to the Ohio Department of Health/Columbus/Etats-Unis (45 aut.); Illinois Department of Public Health/Springfield/Etats-Unis (36 aut., 51 aut.); Epidemic Intelligence Service assigned to the Illinois Department of Public Health/Springfield/Etats-Unis (22 aut.); Michigan Department of Community Health/Lansing/Etats-Unis (9 aut., 44 aut.); Minnesota Department of Health/St. Paul/Etats-Unis (14 aut., 37 aut., 40 aut., 48 aut., 57 aut.); Indiana State Department of Health/Indianapolis/Etats-Unis (4 aut., 27 aut., 47 aut., 52 aut.); Epidemic Intelligence Service assigned to the Pennsylvania Department of Health/Harrisburg/Etats-Unis (7 aut.); Pennsylvania Department of Health/Harrisburg/Etats-Unis (35 aut., 39 aut., 41 aut., 49 aut., 55 aut.); Hawaii Department of Health/Honolulu/Etats-Unis (43 aut.); Ohio Department of Health/Columbus/Etats-Unis (16 aut., 17 aut., 20 aut., 42 aut.); Wisconsin Department of Health Services/Madison/Etats-Unis (26 aut., 32 aut.); West Virginia Bureau for Public Health/Charleston/Etats-Unis (28 aut.); Maryland Department of Health and Mental Hygiene/Baltimore/Etats-Unis (11 aut.) |
DT : | Publication en série; Niveau analytique |
SO : | Clinical infectious diseases; ISSN 1058-4838; Coden CIDIEL; Royaume-Uni; Da. 2013; Vol. 57; No. 12; Pp. 1703-1712; Bibl. 56 ref. |
LA : | Anglais |
EA : | 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 oselta-mivir 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. |
CC : | 002B05 |
FD : | Epidémie; Etats-Unis; Infection; Virus grippal A |
FG : | Amérique du Nord; Amérique; Influenzavirus A; Orthomyxoviridae; Virus |
ED : | Epidemic; United States; Infection; Influenza A virus |
EG : | North America; America; Influenzavirus A; Orthomyxoviridae; Virus |
SD : | Epidemia; Estados Unidos; Infección; Influenza A virus |
LO : | INIST-18407.354000507496890070 |
ID : | 14-0017918 |
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Pascal:14-0017918Le document en format XML
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<affiliation><inist:fA14 i1="05"><s1>Epidemic Intelligence Service assigned to the Illinois Department of Public Health</s1>
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<s3>USA</s3>
<sZ>22 aut.</sZ>
</inist:fA14>
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<author><name sortKey="Greenbaum, Adena" sort="Greenbaum, Adena" uniqKey="Greenbaum A" first="Adena" last="Greenbaum">Adena Greenbaum</name>
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<s3>USA</s3>
<sZ>18 aut.</sZ>
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<affiliation><inist:fA14 i1="02"><s1>Epidemic Intelligence Service assigned to the Influenza Division, Centers for Disease Control and Prevention</s1>
<s2>Atlanta, Georgia</s2>
<s3>USA</s3>
<sZ>18 aut.</sZ>
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<author><name sortKey="Haupt, Thomas" sort="Haupt, Thomas" uniqKey="Haupt T" first="Thomas" last="Haupt">Thomas Haupt</name>
<affiliation><inist:fA14 i1="13"><s1>Wisconsin Department of Health Services</s1>
<s2>Madison</s2>
<s3>USA</s3>
<sZ>26 aut.</sZ>
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</inist:fA14>
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<author><name sortKey="House, Jennifer" sort="House, Jennifer" uniqKey="House J" first="Jennifer" last="House">Jennifer House</name>
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<s2>Indianapolis</s2>
<s3>USA</s3>
<sZ>4 aut.</sZ>
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<author><name sortKey="Ibrahim, Sherif" sort="Ibrahim, Sherif" uniqKey="Ibrahim S" first="Sherif" last="Ibrahim">Sherif Ibrahim</name>
<affiliation><inist:fA14 i1="14"><s1>West Virginia Bureau for Public Health</s1>
<s2>Charleston</s2>
<s3>USA</s3>
<sZ>28 aut.</sZ>
</inist:fA14>
</affiliation>
</author>
<author><name sortKey="Jiang, Victoria" sort="Jiang, Victoria" uniqKey="Jiang V" first="Victoria" last="Jiang">Victoria Jiang</name>
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<s3>USA</s3>
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<author><name sortKey="Jain, Seema" sort="Jain, Seema" uniqKey="Jain S" first="Seema" last="Jain">Seema Jain</name>
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<s3>USA</s3>
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<author><name sortKey="Jernigan, Daniel" sort="Jernigan, Daniel" uniqKey="Jernigan D" first="Daniel" last="Jernigan">Daniel Jernigan</name>
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<s3>USA</s3>
<sZ>1 aut.</sZ>
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<author><name sortKey="Kazmierczak, James" sort="Kazmierczak, James" uniqKey="Kazmierczak J" first="James" last="Kazmierczak">James Kazmierczak</name>
<affiliation><inist:fA14 i1="13"><s1>Wisconsin Department of Health Services</s1>
<s2>Madison</s2>
<s3>USA</s3>
<sZ>26 aut.</sZ>
<sZ>32 aut.</sZ>
</inist:fA14>
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<author><name sortKey="Klimov, Alexander" sort="Klimov, Alexander" uniqKey="Klimov A" first="Alexander" last="Klimov">Alexander Klimov</name>
<affiliation><inist:fA14 i1="01"><s1>Influenza Division, National Center for Immunization and Respiratory Disease</s1>
<s3>USA</s3>
<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
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<author><name sortKey="Lindstrom, Stephen" sort="Lindstrom, Stephen" uniqKey="Lindstrom S" first="Stephen" last="Lindstrom">Stephen Lindstrom</name>
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<s3>USA</s3>
<sZ>1 aut.</sZ>
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<author><name sortKey="Longenberger, Allison" sort="Longenberger, Allison" uniqKey="Longenberger A" first="Allison" last="Longenberger">Allison Longenberger</name>
<affiliation><inist:fA14 i1="10"><s1>Pennsylvania Department of Health</s1>
<s2>Harrisburg</s2>
<s3>USA</s3>
<sZ>35 aut.</sZ>
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<author><name sortKey="Lucas, Paul" sort="Lucas, Paul" uniqKey="Lucas P" first="Paul" last="Lucas">Paul Lucas</name>
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<s2>Springfield</s2>
<s3>USA</s3>
<sZ>36 aut.</sZ>
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</inist:fA14>
</affiliation>
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<author><name sortKey="Lynfield, Ruth" sort="Lynfield, Ruth" uniqKey="Lynfield R" first="Ruth" last="Lynfield">Ruth Lynfield</name>
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<s2>St. Paul</s2>
<s3>USA</s3>
<sZ>14 aut.</sZ>
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<author><name sortKey="Mcmorrow, Meredith" sort="Mcmorrow, Meredith" uniqKey="Mcmorrow M" first="Meredith" last="Mcmorrow">Meredith Mcmorrow</name>
<affiliation><inist:fA14 i1="01"><s1>Influenza Division, National Center for Immunization and Respiratory Disease</s1>
<s3>USA</s3>
<sZ>1 aut.</sZ>
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<author><name sortKey="Moll, Maria" sort="Moll, Maria" uniqKey="Moll M" first="Maria" last="Moll">Maria Moll</name>
<affiliation><inist:fA14 i1="10"><s1>Pennsylvania Department of Health</s1>
<s2>Harrisburg</s2>
<s3>USA</s3>
<sZ>35 aut.</sZ>
<sZ>39 aut.</sZ>
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<author><name sortKey="Morin, Craig" sort="Morin, Craig" uniqKey="Morin C" first="Craig" last="Morin">Craig Morin</name>
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<s2>St. Paul</s2>
<s3>USA</s3>
<sZ>14 aut.</sZ>
<sZ>37 aut.</sZ>
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<author><name sortKey="Ostroff, Stephen" sort="Ostroff, Stephen" uniqKey="Ostroff S" first="Stephen" last="Ostroff">Stephen Ostroff</name>
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<s2>Harrisburg</s2>
<s3>USA</s3>
<sZ>35 aut.</sZ>
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<author><name sortKey="Page, Shannon L" sort="Page, Shannon L" uniqKey="Page S" first="Shannon L." last="Page">Shannon L. Page</name>
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<s2>Columbus</s2>
<s3>USA</s3>
<sZ>16 aut.</sZ>
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<author><name sortKey="Park, Sarah Y" sort="Park, Sarah Y" uniqKey="Park S" first="Sarah Y." last="Park">Sarah Y. Park</name>
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<s2>Honolulu</s2>
<s3>USA</s3>
<sZ>43 aut.</sZ>
</inist:fA14>
</affiliation>
</author>
<author><name sortKey="Peters, Susan" sort="Peters, Susan" uniqKey="Peters S" first="Susan" last="Peters">Susan Peters</name>
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<s2>Lansing</s2>
<s3>USA</s3>
<sZ>9 aut.</sZ>
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</inist:fA14>
</affiliation>
</author>
<author><name sortKey="Quinn, Celia" sort="Quinn, Celia" uniqKey="Quinn C" first="Celia" last="Quinn">Celia Quinn</name>
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<s2>Columbus</s2>
<s3>USA</s3>
<sZ>45 aut.</sZ>
</inist:fA14>
</affiliation>
</author>
<author><name sortKey="Reed, Carrie" sort="Reed, Carrie" uniqKey="Reed C" first="Carrie" last="Reed">Carrie Reed</name>
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<s3>USA</s3>
<sZ>1 aut.</sZ>
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</author>
<author><name sortKey="Richards, Shawn" sort="Richards, Shawn" uniqKey="Richards S" first="Shawn" last="Richards">Shawn Richards</name>
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<s2>Indianapolis</s2>
<s3>USA</s3>
<sZ>4 aut.</sZ>
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</author>
<author><name sortKey="Scheftel, Joni" sort="Scheftel, Joni" uniqKey="Scheftel J" first="Joni" last="Scheftel">Joni Scheftel</name>
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<s2>St. Paul</s2>
<s3>USA</s3>
<sZ>14 aut.</sZ>
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</author>
<author><name sortKey="Simwale, Owen" sort="Simwale, Owen" uniqKey="Simwale O" first="Owen" last="Simwale">Owen Simwale</name>
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<s2>Harrisburg</s2>
<s3>USA</s3>
<sZ>35 aut.</sZ>
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</author>
<author><name sortKey="Bo Shu" sort="Bo Shu" uniqKey="Bo Shu" last="Bo Shu">BO SHU</name>
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<author><name sortKey="Soyemi, Kenneth" sort="Soyemi, Kenneth" uniqKey="Soyemi K" first="Kenneth" last="Soyemi">Kenneth Soyemi</name>
<affiliation><inist:fA14 i1="04"><s1>Illinois Department of Public Health</s1>
<s2>Springfield</s2>
<s3>USA</s3>
<sZ>36 aut.</sZ>
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</inist:fA14>
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</author>
<author><name sortKey="Stauffer, Jill" sort="Stauffer, Jill" uniqKey="Stauffer J" first="Jill" last="Stauffer">Jill Stauffer</name>
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<s3>USA</s3>
<sZ>4 aut.</sZ>
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</inist:fA14>
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</author>
<author><name sortKey="Steffens, Craig" sort="Steffens, Craig" uniqKey="Steffens C" first="Craig" last="Steffens">Craig Steffens</name>
</author>
<author><name sortKey="Su Su" sort="Su Su" uniqKey="Su Su" last="Su Su">SU SU</name>
</author>
<author><name sortKey="Torso, Lauren" sort="Torso, Lauren" uniqKey="Torso L" first="Lauren" last="Torso">Lauren Torso</name>
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<s3>USA</s3>
<sZ>35 aut.</sZ>
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</author>
<author><name sortKey="Uyeki, Timothy M" sort="Uyeki, Timothy M" uniqKey="Uyeki T" first="Timothy M." last="Uyeki">Timothy M. Uyeki</name>
</author>
<author><name sortKey="Vetter, Sara" sort="Vetter, Sara" uniqKey="Vetter S" first="Sara" last="Vetter">Sara Vetter</name>
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<s2>St. Paul</s2>
<s3>USA</s3>
<sZ>14 aut.</sZ>
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</author>
<author><name sortKey="Villanueva, Julie" sort="Villanueva, Julie" uniqKey="Villanueva J" first="Julie" last="Villanueva">Julie Villanueva</name>
</author>
<author><name sortKey="Wong, Karen K" sort="Wong, Karen K" uniqKey="Wong K" first="Karen K." last="Wong">Karen K. Wong</name>
<affiliation><inist:fA14 i1="02"><s1>Epidemic Intelligence Service assigned to the Influenza Division, Centers for Disease Control and Prevention</s1>
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<s3>USA</s3>
<sZ>18 aut.</sZ>
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</author>
<author><name sortKey="Shaw, Michael" sort="Shaw, Michael" uniqKey="Shaw M" first="Michael" last="Shaw">Michael Shaw</name>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">INIST</idno>
<idno type="inist">14-0017918</idno>
<date when="2013">2013</date>
<idno type="stanalyst">PASCAL 14-0017918 INIST</idno>
<idno type="RBID">Pascal:14-0017918</idno>
<idno type="wicri:Area/PascalFrancis/Corpus">000166</idno>
</publicationStmt>
<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Outbreak of Variant Influenza A(H3N2) Virus in the United States</title>
<author><name sortKey="Jhung, Michael A" sort="Jhung, Michael A" uniqKey="Jhung M" first="Michael A." last="Jhung">Michael A. Jhung</name>
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<sZ>1 aut.</sZ>
<sZ>2 aut.</sZ>
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</author>
<author><name sortKey="Epperson, Scott" sort="Epperson, Scott" uniqKey="Epperson S" first="Scott" last="Epperson">Scott Epperson</name>
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<sZ>1 aut.</sZ>
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<author><name sortKey="Allen, Donna" sort="Allen, Donna" uniqKey="Allen D" first="Donna" last="Allen">Donna Allen</name>
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<s2>Indianapolis</s2>
<s3>USA</s3>
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<affiliation><inist:fA14 i1="01"><s1>Influenza Division, National Center for Immunization and Respiratory Disease</s1>
<s3>USA</s3>
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<author><name sortKey="Beaudoin, Amanda" sort="Beaudoin, Amanda" uniqKey="Beaudoin A" first="Amanda" last="Beaudoin">Amanda Beaudoin</name>
<affiliation><inist:fA14 i1="09"><s1>Epidemic Intelligence Service assigned to the Pennsylvania Department of Health</s1>
<s2>Harrisburg</s2>
<s3>USA</s3>
<sZ>7 aut.</sZ>
</inist:fA14>
</affiliation>
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<author><name sortKey="Berman, Lashondra" sort="Berman, Lashondra" uniqKey="Berman L" first="Lashondra" last="Berman">Lashondra Berman</name>
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<author><name sortKey="Bidol, Sally" sort="Bidol, Sally" uniqKey="Bidol S" first="Sally" last="Bidol">Sally Bidol</name>
<affiliation><inist:fA14 i1="06"><s1>Michigan Department of Community Health</s1>
<s2>Lansing</s2>
<s3>USA</s3>
<sZ>9 aut.</sZ>
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</inist:fA14>
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<author><name sortKey="Blanton, Lenee" sort="Blanton, Lenee" uniqKey="Blanton L" first="Lenee" last="Blanton">Lenee Blanton</name>
<affiliation><inist:fA14 i1="01"><s1>Influenza Division, National Center for Immunization and Respiratory Disease</s1>
<s3>USA</s3>
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<author><name sortKey="Blythe, David" sort="Blythe, David" uniqKey="Blythe D" first="David" last="Blythe">David Blythe</name>
<affiliation><inist:fA14 i1="15"><s1>Maryland Department of Health and Mental Hygiene</s1>
<s2>Baltimore</s2>
<s3>USA</s3>
<sZ>11 aut.</sZ>
</inist:fA14>
</affiliation>
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<author><name sortKey="Brammer, Lynnette" sort="Brammer, Lynnette" uniqKey="Brammer L" first="Lynnette" last="Brammer">Lynnette Brammer</name>
<affiliation><inist:fA14 i1="01"><s1>Influenza Division, National Center for Immunization and Respiratory Disease</s1>
<s3>USA</s3>
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<author><name sortKey="D Mello, Tiffany" sort="D Mello, Tiffany" uniqKey="D Mello T" first="Tiffany" last="D'Mello">Tiffany D'Mello</name>
<affiliation><inist:fA14 i1="01"><s1>Influenza Division, National Center for Immunization and Respiratory Disease</s1>
<s3>USA</s3>
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<author><name sortKey="Danila, Richard" sort="Danila, Richard" uniqKey="Danila R" first="Richard" last="Danila">Richard Danila</name>
<affiliation><inist:fA14 i1="07"><s1>Minnesota Department of Health</s1>
<s2>St. Paul</s2>
<s3>USA</s3>
<sZ>14 aut.</sZ>
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<author><name sortKey="Davis, William" sort="Davis, William" uniqKey="Davis W" first="William" last="Davis">William Davis</name>
<affiliation><inist:fA14 i1="01"><s1>Influenza Division, National Center for Immunization and Respiratory Disease</s1>
<s3>USA</s3>
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<author><name sortKey="De Fijter, Sietske" sort="De Fijter, Sietske" uniqKey="De Fijter S" first="Sietske" last="De Fijter">Sietske De Fijter</name>
<affiliation><inist:fA14 i1="12"><s1>Ohio Department of Health</s1>
<s2>Columbus</s2>
<s3>USA</s3>
<sZ>16 aut.</sZ>
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<author><name sortKey="Diorio, Mary" sort="Diorio, Mary" uniqKey="Diorio M" first="Mary" last="Diorio">Mary Diorio</name>
<affiliation><inist:fA14 i1="12"><s1>Ohio Department of Health</s1>
<s2>Columbus</s2>
<s3>USA</s3>
<sZ>16 aut.</sZ>
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</author>
<author><name sortKey="Durand, Lizette O" sort="Durand, Lizette O" uniqKey="Durand L" first="Lizette O." last="Durand">Lizette O. Durand</name>
<affiliation><inist:fA14 i1="02"><s1>Epidemic Intelligence Service assigned to the Influenza Division, Centers for Disease Control and Prevention</s1>
<s2>Atlanta, Georgia</s2>
<s3>USA</s3>
<sZ>18 aut.</sZ>
<sZ>23 aut.</sZ>
<sZ>25 aut.</sZ>
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</affiliation>
</author>
<author><name sortKey="Emery, Shannon" sort="Emery, Shannon" uniqKey="Emery S" first="Shannon" last="Emery">Shannon Emery</name>
<affiliation><inist:fA14 i1="01"><s1>Influenza Division, National Center for Immunization and Respiratory Disease</s1>
<s3>USA</s3>
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<author><name sortKey="Fowler, Brian" sort="Fowler, Brian" uniqKey="Fowler B" first="Brian" last="Fowler">Brian Fowler</name>
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<s2>Columbus</s2>
<s3>USA</s3>
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<author><name sortKey="Garten, Rebecca" sort="Garten, Rebecca" uniqKey="Garten R" first="Rebecca" last="Garten">Rebecca Garten</name>
<affiliation><inist:fA14 i1="01"><s1>Influenza Division, National Center for Immunization and Respiratory Disease</s1>
<s3>USA</s3>
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<author><name sortKey="Grant, Yoran" sort="Grant, Yoran" uniqKey="Grant Y" first="Yoran" last="Grant">Yoran Grant</name>
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<s2>Springfield</s2>
<s3>USA</s3>
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</inist:fA14>
</affiliation>
</author>
<author><name sortKey="Greenbaum, Adena" sort="Greenbaum, Adena" uniqKey="Greenbaum A" first="Adena" last="Greenbaum">Adena Greenbaum</name>
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<s2>Atlanta, Georgia</s2>
<s3>USA</s3>
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</author>
<author><name sortKey="Gubareva, Larisa" sort="Gubareva, Larisa" uniqKey="Gubareva L" first="Larisa" last="Gubareva">Larisa Gubareva</name>
<affiliation><inist:fA14 i1="01"><s1>Influenza Division, National Center for Immunization and Respiratory Disease</s1>
<s3>USA</s3>
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<author><name sortKey="Havers, Fiona" sort="Havers, Fiona" uniqKey="Havers F" first="Fiona" last="Havers">Fiona Havers</name>
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<s2>Atlanta, Georgia</s2>
<s3>USA</s3>
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<author><name sortKey="Haupt, Thomas" sort="Haupt, Thomas" uniqKey="Haupt T" first="Thomas" last="Haupt">Thomas Haupt</name>
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</inist:fA14>
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<author><name sortKey="House, Jennifer" sort="House, Jennifer" uniqKey="House J" first="Jennifer" last="House">Jennifer House</name>
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<s3>USA</s3>
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<author><name sortKey="Ibrahim, Sherif" sort="Ibrahim, Sherif" uniqKey="Ibrahim S" first="Sherif" last="Ibrahim">Sherif Ibrahim</name>
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<s2>Charleston</s2>
<s3>USA</s3>
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</inist:fA14>
</affiliation>
</author>
<author><name sortKey="Jiang, Victoria" sort="Jiang, Victoria" uniqKey="Jiang V" first="Victoria" last="Jiang">Victoria Jiang</name>
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<author><name sortKey="Jain, Seema" sort="Jain, Seema" uniqKey="Jain S" first="Seema" last="Jain">Seema Jain</name>
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<author><name sortKey="Jernigan, Daniel" sort="Jernigan, Daniel" uniqKey="Jernigan D" first="Daniel" last="Jernigan">Daniel Jernigan</name>
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<author><name sortKey="Kazmierczak, James" sort="Kazmierczak, James" uniqKey="Kazmierczak J" first="James" last="Kazmierczak">James Kazmierczak</name>
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<s2>Madison</s2>
<s3>USA</s3>
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</inist:fA14>
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<author><name sortKey="Klimov, Alexander" sort="Klimov, Alexander" uniqKey="Klimov A" first="Alexander" last="Klimov">Alexander Klimov</name>
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<sZ>1 aut.</sZ>
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<author><name sortKey="Lindstrom, Stephen" sort="Lindstrom, Stephen" uniqKey="Lindstrom S" first="Stephen" last="Lindstrom">Stephen Lindstrom</name>
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<s2>Harrisburg</s2>
<s3>USA</s3>
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<s2>Honolulu</s2>
<s3>USA</s3>
<sZ>43 aut.</sZ>
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<affiliation><inist:fA14 i1="03"><s1>Epidemic Intelligence Service assigned to the Ohio Department of Health</s1>
<s2>Columbus</s2>
<s3>USA</s3>
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<affiliation><inist:fA14 i1="08"><s1>Indiana State Department of Health</s1>
<s2>Indianapolis</s2>
<s3>USA</s3>
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<author><name sortKey="Scheftel, Joni" sort="Scheftel, Joni" uniqKey="Scheftel J" first="Joni" last="Scheftel">Joni Scheftel</name>
<affiliation><inist:fA14 i1="07"><s1>Minnesota Department of Health</s1>
<s2>St. Paul</s2>
<s3>USA</s3>
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<affiliation><inist:fA14 i1="10"><s1>Pennsylvania Department of Health</s1>
<s2>Harrisburg</s2>
<s3>USA</s3>
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</author>
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<affiliation><inist:fA14 i1="04"><s1>Illinois Department of Public Health</s1>
<s2>Springfield</s2>
<s3>USA</s3>
<sZ>36 aut.</sZ>
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<author><name sortKey="Stauffer, Jill" sort="Stauffer, Jill" uniqKey="Stauffer J" first="Jill" last="Stauffer">Jill Stauffer</name>
<affiliation><inist:fA14 i1="08"><s1>Indiana State Department of Health</s1>
<s2>Indianapolis</s2>
<s3>USA</s3>
<sZ>4 aut.</sZ>
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<affiliation><inist:fA14 i1="10"><s1>Pennsylvania Department of Health</s1>
<s2>Harrisburg</s2>
<s3>USA</s3>
<sZ>35 aut.</sZ>
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</author>
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<s2>St. Paul</s2>
<s3>USA</s3>
<sZ>14 aut.</sZ>
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</author>
<author><name sortKey="Villanueva, Julie" sort="Villanueva, Julie" uniqKey="Villanueva J" first="Julie" last="Villanueva">Julie Villanueva</name>
</author>
<author><name sortKey="Wong, Karen K" sort="Wong, Karen K" uniqKey="Wong K" first="Karen K." last="Wong">Karen K. Wong</name>
<affiliation><inist:fA14 i1="02"><s1>Epidemic Intelligence Service assigned to the Influenza Division, Centers for Disease Control and Prevention</s1>
<s2>Atlanta, Georgia</s2>
<s3>USA</s3>
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</author>
</analytic>
<series><title level="j" type="main">Clinical infectious diseases</title>
<title level="j" type="abbreviated">Clin. infect. dis.</title>
<idno type="ISSN">1058-4838</idno>
<imprint><date when="2013">2013</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt><title level="j" type="main">Clinical infectious diseases</title>
<title level="j" type="abbreviated">Clin. infect. dis.</title>
<idno type="ISSN">1058-4838</idno>
</seriesStmt>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Epidemic</term>
<term>Infection</term>
<term>Influenza A virus</term>
<term>United States</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>Epidémie</term>
<term>Etats-Unis</term>
<term>Infection</term>
<term>Virus grippal A</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en">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 oselta-mivir 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.</div>
</front>
</TEI>
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<fA08 i1="01" i2="1" l="ENG"><s1>Outbreak of Variant Influenza A(H3N2) Virus in the United States</s1>
</fA08>
<fA11 i1="01" i2="1"><s1>JHUNG (Michael A.)</s1>
</fA11>
<fA11 i1="02" i2="1"><s1>EPPERSON (Scott)</s1>
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<fA11 i1="03" i2="1"><s1>BIGGERSTAFF (Matthew)</s1>
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<fA11 i1="13" i2="1"><s1>D'MELLO (Tiffany)</s1>
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<fA11 i1="15" i2="1"><s1>DAVIS (William)</s1>
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<fA11 i1="16" i2="1"><s1>DE FIJTER (Sietske)</s1>
</fA11>
<fA11 i1="17" i2="1"><s1>DIORIO (Mary)</s1>
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<fA11 i1="18" i2="1"><s1>DURAND (Lizette O.)</s1>
</fA11>
<fA11 i1="19" i2="1"><s1>EMERY (Shannon)</s1>
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<fA11 i1="20" i2="1"><s1>FOWLER (Brian)</s1>
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<fA11 i1="21" i2="1"><s1>GARTEN (Rebecca)</s1>
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<fA11 i1="22" i2="1"><s1>GRANT (Yoran)</s1>
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<fA11 i1="23" i2="1"><s1>GREENBAUM (Adena)</s1>
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<fA11 i1="24" i2="1"><s1>GUBAREVA (Larisa)</s1>
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<fA11 i1="25" i2="1"><s1>HAVERS (Fiona)</s1>
</fA11>
<fA11 i1="26" i2="1"><s1>HAUPT (Thomas)</s1>
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<fA11 i1="27" i2="1"><s1>HOUSE (Jennifer)</s1>
</fA11>
<fA11 i1="28" i2="1"><s1>IBRAHIM (Sherif)</s1>
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<fA11 i1="29" i2="1"><s1>JIANG (Victoria)</s1>
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<fA11 i1="30" i2="1"><s1>JAIN (Seema)</s1>
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<fA11 i1="32" i2="1"><s1>KAZMIERCZAK (James)</s1>
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<fA11 i1="33" i2="1"><s1>KLIMOV (Alexander)</s1>
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<fA11 i1="34" i2="1"><s1>LINDSTROM (Stephen)</s1>
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<fA11 i1="36" i2="1"><s1>LUCAS (Paul)</s1>
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<fA11 i1="37" i2="1"><s1>LYNFIELD (Ruth)</s1>
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<fA11 i1="38" i2="1"><s1>MCMORROW (Meredith)</s1>
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<fA11 i1="39" i2="1"><s1>MOLL (Maria)</s1>
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<fA11 i1="40" i2="1"><s1>MORIN (Craig)</s1>
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<fA11 i1="41" i2="1"><s1>OSTROFF (Stephen)</s1>
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<fA11 i1="42" i2="1"><s1>PAGE (Shannon L.)</s1>
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<fA11 i1="43" i2="1"><s1>PARK (Sarah Y.)</s1>
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<fA11 i1="50" i2="1"><s1>BO SHU</s1>
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<fA11 i1="59" i2="1"><s1>WONG (Karen K.)</s1>
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<fA11 i1="60" i2="1"><s1>SHAW (Michael)</s1>
</fA11>
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<sZ>38 aut.</sZ>
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<fA14 i1="02"><s1>Epidemic Intelligence Service assigned to the Influenza Division, Centers for Disease Control and Prevention</s1>
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<sZ>23 aut.</sZ>
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<fA14 i1="03"><s1>Epidemic Intelligence Service assigned to the Ohio Department of Health</s1>
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<sZ>45 aut.</sZ>
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<sZ>51 aut.</sZ>
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<sZ>22 aut.</sZ>
</fA14>
<fA14 i1="06"><s1>Michigan Department of Community Health</s1>
<s2>Lansing</s2>
<s3>USA</s3>
<sZ>9 aut.</sZ>
<sZ>44 aut.</sZ>
</fA14>
<fA14 i1="07"><s1>Minnesota Department of Health</s1>
<s2>St. Paul</s2>
<s3>USA</s3>
<sZ>14 aut.</sZ>
<sZ>37 aut.</sZ>
<sZ>40 aut.</sZ>
<sZ>48 aut.</sZ>
<sZ>57 aut.</sZ>
</fA14>
<fA14 i1="08"><s1>Indiana State Department of Health</s1>
<s2>Indianapolis</s2>
<s3>USA</s3>
<sZ>4 aut.</sZ>
<sZ>27 aut.</sZ>
<sZ>47 aut.</sZ>
<sZ>52 aut.</sZ>
</fA14>
<fA14 i1="09"><s1>Epidemic Intelligence Service assigned to the Pennsylvania Department of Health</s1>
<s2>Harrisburg</s2>
<s3>USA</s3>
<sZ>7 aut.</sZ>
</fA14>
<fA14 i1="10"><s1>Pennsylvania Department of Health</s1>
<s2>Harrisburg</s2>
<s3>USA</s3>
<sZ>35 aut.</sZ>
<sZ>39 aut.</sZ>
<sZ>41 aut.</sZ>
<sZ>49 aut.</sZ>
<sZ>55 aut.</sZ>
</fA14>
<fA14 i1="11"><s1>Hawaii Department of Health</s1>
<s2>Honolulu</s2>
<s3>USA</s3>
<sZ>43 aut.</sZ>
</fA14>
<fA14 i1="12"><s1>Ohio Department of Health</s1>
<s2>Columbus</s2>
<s3>USA</s3>
<sZ>16 aut.</sZ>
<sZ>17 aut.</sZ>
<sZ>20 aut.</sZ>
<sZ>42 aut.</sZ>
</fA14>
<fA14 i1="13"><s1>Wisconsin Department of Health Services</s1>
<s2>Madison</s2>
<s3>USA</s3>
<sZ>26 aut.</sZ>
<sZ>32 aut.</sZ>
</fA14>
<fA14 i1="14"><s1>West Virginia Bureau for Public Health</s1>
<s2>Charleston</s2>
<s3>USA</s3>
<sZ>28 aut.</sZ>
</fA14>
<fA14 i1="15"><s1>Maryland Department of Health and Mental Hygiene</s1>
<s2>Baltimore</s2>
<s3>USA</s3>
<sZ>11 aut.</sZ>
</fA14>
<fA20><s1>1703-1712</s1>
</fA20>
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<s1>© 2014 INIST-CNRS. All rights reserved.</s1>
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<fA66 i1="01"><s0>GBR</s0>
</fA66>
<fC01 i1="01" l="ENG"><s0>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 oselta-mivir 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.</s0>
</fC01>
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<s2>NG</s2>
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<s2>NG</s2>
<s5>08</s5>
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<s5>09</s5>
</fC03>
<fC03 i1="03" i2="X" l="ENG"><s0>Infection</s0>
<s5>09</s5>
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<fC03 i1="03" i2="X" l="SPA"><s0>Infección</s0>
<s5>09</s5>
</fC03>
<fC03 i1="04" i2="X" l="FRE"><s0>Virus grippal A</s0>
<s2>NW</s2>
<s5>10</s5>
</fC03>
<fC03 i1="04" i2="X" l="ENG"><s0>Influenza A virus</s0>
<s2>NW</s2>
<s5>10</s5>
</fC03>
<fC03 i1="04" i2="X" l="SPA"><s0>Influenza A virus</s0>
<s2>NW</s2>
<s5>10</s5>
</fC03>
<fC07 i1="01" i2="X" l="FRE"><s0>Amérique du Nord</s0>
<s2>NG</s2>
</fC07>
<fC07 i1="01" i2="X" l="ENG"><s0>North America</s0>
<s2>NG</s2>
</fC07>
<fC07 i1="01" i2="X" l="SPA"><s0>America del norte</s0>
<s2>NG</s2>
</fC07>
<fC07 i1="02" i2="X" l="FRE"><s0>Amérique</s0>
<s2>NG</s2>
</fC07>
<fC07 i1="02" i2="X" l="ENG"><s0>America</s0>
<s2>NG</s2>
</fC07>
<fC07 i1="02" i2="X" l="SPA"><s0>America</s0>
<s2>NG</s2>
</fC07>
<fC07 i1="03" i2="X" l="FRE"><s0>Influenzavirus A</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="03" i2="X" l="ENG"><s0>Influenzavirus A</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="03" i2="X" l="SPA"><s0>Influenzavirus A</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="04" i2="X" l="FRE"><s0>Orthomyxoviridae</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="04" i2="X" l="ENG"><s0>Orthomyxoviridae</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="04" i2="X" l="SPA"><s0>Orthomyxoviridae</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="05" i2="X" l="FRE"><s0>Virus</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="05" i2="X" l="ENG"><s0>Virus</s0>
<s2>NW</s2>
</fC07>
<fC07 i1="05" i2="X" l="SPA"><s0>Virus</s0>
<s2>NW</s2>
</fC07>
<fN21><s1>020</s1>
</fN21>
<fN44 i1="01"><s1>OTO</s1>
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<fN82><s1>OTO</s1>
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<server><NO>PASCAL 14-0017918 INIST</NO>
<ET>Outbreak of Variant Influenza A(H3N2) Virus in the United States</ET>
<AU>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); BO SHU; SOYEMI (Kenneth); STAUFFER (Jill); STEFFENS (Craig); SU SU; TORSO (Lauren); UYEKI (Timothy M.); VETTER (Sara); VILLANUEVA (Julie); WONG (Karen K.); SHAW (Michael)</AU>
<AF>Influenza Division, National Center for Immunization and Respiratory Disease/Etats-Unis (1 aut., 2 aut., 3 aut., 5 aut., 6 aut., 8 aut., 10 aut., 12 aut., 13 aut., 15 aut., 19 aut., 21 aut., 24 aut., 29 aut., 30 aut., 31 aut., 33 aut., 34 aut., 38 aut., 46 aut.); Epidemic Intelligence Service assigned to the Influenza Division, Centers for Disease Control and Prevention/Atlanta, Georgia/Etats-Unis (18 aut., 23 aut., 25 aut., 59 aut.); Epidemic Intelligence Service assigned to the Ohio Department of Health/Columbus/Etats-Unis (45 aut.); Illinois Department of Public Health/Springfield/Etats-Unis (36 aut., 51 aut.); Epidemic Intelligence Service assigned to the Illinois Department of Public Health/Springfield/Etats-Unis (22 aut.); Michigan Department of Community Health/Lansing/Etats-Unis (9 aut., 44 aut.); Minnesota Department of Health/St. Paul/Etats-Unis (14 aut., 37 aut., 40 aut., 48 aut., 57 aut.); Indiana State Department of Health/Indianapolis/Etats-Unis (4 aut., 27 aut., 47 aut., 52 aut.); Epidemic Intelligence Service assigned to the Pennsylvania Department of Health/Harrisburg/Etats-Unis (7 aut.); Pennsylvania Department of Health/Harrisburg/Etats-Unis (35 aut., 39 aut., 41 aut., 49 aut., 55 aut.); Hawaii Department of Health/Honolulu/Etats-Unis (43 aut.); Ohio Department of Health/Columbus/Etats-Unis (16 aut., 17 aut., 20 aut., 42 aut.); Wisconsin Department of Health Services/Madison/Etats-Unis (26 aut., 32 aut.); West Virginia Bureau for Public Health/Charleston/Etats-Unis (28 aut.); Maryland Department of Health and Mental Hygiene/Baltimore/Etats-Unis (11 aut.)</AF>
<DT>Publication en série; Niveau analytique</DT>
<SO>Clinical infectious diseases; ISSN 1058-4838; Coden CIDIEL; Royaume-Uni; Da. 2013; Vol. 57; No. 12; Pp. 1703-1712; Bibl. 56 ref.</SO>
<LA>Anglais</LA>
<EA>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 oselta-mivir 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.</EA>
<CC>002B05</CC>
<FD>Epidémie; Etats-Unis; Infection; Virus grippal A</FD>
<FG>Amérique du Nord; Amérique; Influenzavirus A; Orthomyxoviridae; Virus</FG>
<ED>Epidemic; United States; Infection; Influenza A virus</ED>
<EG>North America; America; Influenzavirus A; Orthomyxoviridae; Virus</EG>
<SD>Epidemia; Estados Unidos; Infección; Influenza A virus</SD>
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<ID>14-0017918</ID>
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