Infection caused by influenza viruses endemic to pigs
Medical condition
Swine influenza is an infection caused by any of several types of swine influenza viruses. Swine influenza virus (SIV) or swine-origin influenza virus (S-OIV) refers to any strain of the influenza family of viruses that is endemic in pigs. As of 2009, identified SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H2N1, H3N1, H3N2, and H2N3.
The swine influenza virus is common throughout pig populations worldwide. Transmission of the virus from pigs to humans is rare and does not always lead to human illness, often resulting only in the production of antibodies in the blood. If transmission causes human illness, it is called a zoonotic swine flu. People with regular exposure to pigs are at increased risk of swine flu infections.
Around the mid-20th century, the identification of influenza subtypes was made possible, allowing accurate diagnosis of transmission to humans. Since then, only 50 such transmissions have been confirmed. These strains of swine flu rarely pass from human to human. Symptoms of zoonotic swine flu in humans are similar to those of influenza and influenza-like illness and include chills, fever, sore throat, muscle pains, severe headache, coughing, weakness, shortness of breath, and general discomfort.
It is estimated that, in the 2009 flu pandemic, 11–21% of the then global population (of about 6.8 billion), equivalent to around 700 million to 1.4 billion people, contracted the illness—more, in absolute terms, than the Spanish flu pandemic. There were 18,449 confirmed fatalities. However, in a 2012 study, the CDC estimated more than 284,000 possible fatalities worldwide, with numbers ranging from 150,000 to 575,000.
In August 2010, the World Health Organization declared the swine flu pandemic officially over.
Subsequent cases of swine flu were reported in India in 2015, with over 31,156 positive test cases and 1,841 deaths.
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Signs and symptoms.
In pigs, a swine influenza infection produces fever, lethargy, discharge from the nose or eyes, sneezing, coughing, difficulty breathing, eye redness or inflammation, and decreased appetite. In some cases, the infection can cause miscarriage. However, infected pigs may not exhibit any symptoms. Although mortality is usually low (around 1–4%), the virus can cause weight loss and poor growth, in turn causing economic loss to farmers. Infected pigs can lose up to 12 pounds of body weight over a three- to four-week period. Influenza A is responsible for infecting swine and was first identified in 1918. Because both avian and mammalian influenza viruses can bind to receptors in pigs, pigs have often been seen as "mixing vessels", facilitating the evolution of strains that can be passed on to other mammals, such as humans.
Humans.
Direct transmission of a swine flu virus from pigs to humans is possible (zoonotic swine flu). Fifty cases are known to have occurred since the first report in medical literature in 1958, which have resulted in a total of six deaths. Of these six people, one was pregnant, one had leukemia, one had Hodgkin's lymphoma, and two were known to be previously healthy. No medical history was reported for the remaining case The true rate of infection may be higher, as most cases only cause a very mild disease and may never be reported or diagnosed.
According to the United States Centers for Disease Control and Prevention (CDC), in humans the symptoms of the 2009 "swine flu" H1N1 virus are similar to influenza and influenza-like illness. Symptoms include fever, cough, sore throat, watery eyes, body aches, shortness of breath, headache, weight loss, chills, sneezing, runny nose, coughing, dizziness, abdominal pain, lack of appetite, and fatigue. During the 2009 outbreak, an elevated percentage of patients reporting diarrhea and vomiting.
Because these symptoms are not specific to swine flu, a differential diagnosis of "probable" swine flu requires not only symptoms, but also a high likelihood of swine flu due to the person's recent and past medical history. For example, during the 2009 swine flu outbreak in the United States, the CDC advised physicians to "consider swine influenza infection in the differential diagnosis of patients with acute febrile respiratory illness who have either been in contact with persons with confirmed swine flu, or who were in one of the five U.S. states that have reported swine flu cases or in Mexico during the seven days preceding their illness onset." A diagnosis of "confirmed" swine flu requires laboratory testing of a respiratory sample (a simple nose and throat swab).
The most common cause of death is respiratory failure. Other causes of death are pneumonia (leading to sepsis), high fever (leading to neurological problems), dehydration (from excessive vomiting and diarrhea), electrolyte imbalance and kidney failure. Fatalities are more likely in young children and the elderly.
Virology.
Transmission.
Between pigs.
Influenza is common in pigs. About half of breeding pigs in the USA have been exposed to the virus. Antibodies to the virus are also common in pigs in other countries.
The main route of transmission is through direct contact between infected and uninfected animals. These close contacts are particularly common during animal transport. Intensive farming may also increase the risk of transmission, as the pigs are raised in very close proximity to each other. Direct transfer of the virus probably occurs though pigs touching noses or through dried mucus. Airborne transmission through the aerosols produced by pigs coughing or sneezing are also an important means of infection. The virus usually spreads quickly through a herd, infecting all the pigs within just a few days. Transmission may also occur through wild animals, such as wild boar, which can spread the disease between farms.
To humans.
People who work with poultry and swine, especially those with intense exposures, are at increased risk of zoonotic infection with influenza virus endemic in these animals, and constitute a population of human hosts in which zoonosis and reassortment can co-occur. Vaccination of these workers against influenza and surveillance for new influenza strains among this population may therefore be an important public health measure. Transmission of influenza from swine to humans who work with swine was documented in a small surveillance study performed in 2004 at the University of Iowa. This study, among others, forms the basis of a recommendation that people whose jobs involve handling poultry and swine be the focus of increased public health surveillance. Other professions at particular risk of infection are veterinarians and meat processing workers, although the risk of infection for both of these groups is lower than that of farm workers.
Interaction with avian H5N1 in pigs.
Pigs are unusual because they can be infected with influenza strains that usually infect three different species: pigs, birds, and humans. Within pigs, influenza viruses may exchange genes and produce novel strains. Avian influenza virus H3N2 is endemic in pigs in China and has been detected in pigs in Vietnam, increasing fears of the emergence of new variant strains. H3N2 evolved from H2N2 by antigenic shift. In August 2004, researchers in China found H5N1 in pigs.
These H5N1 infections may be common. In a survey of 10 apparently healthy pigs housed near poultry farms in West Java, where avian flu had broken out, five of the pig samples contained the H5N1 virus. The Indonesian government found similar results in the same region, though additional tests of 150 pigs outside the area were negative.
Structure.
The influenza virion is roughly spherical. It is an enveloped virus; the outer layer is a lipid membrane which is taken from the host cell in which the virus multiplies. Inserted into the lipid membrane are glycoprotein "spikes" of hemagglutinin (HA) and neuraminidase (NA). The combination of HA and NA proteins determine the subtype of influenza virus (A/H1N1, for example). HA and NA are important in the immune response against the virus, and antibodies against these spikes may protect against infection. The antiviral drugs Relenza and Tamiflu target NA by inhibiting neuraminidase and preventing the release of viruses from host cells. Also embedded in the lipid membrane is the M2 protein, which is the target of the antiviral adamantanes amantadine and rimantadine.
Classification.
Of the three genera of influenza viruses that cause human flu, two also cause influenza in pigs, with influenza A being common in pigs and influenza C being rare. Influenza B has not been reported in pigs. Within influenza A and influenza C, the strains found in pigs and humans are largely distinct, although because of reassortment there have been transfers of genes among strains crossing swine, avian, and human species boundaries.
Influenza C.
Influenza viruses infect both humans and pigs, but do not infect birds. Transmission between pigs and humans have occurred in the past. For example, influenza C caused small outbreaks of a mild form of influenza amongst children in Japan and California. As a result of the limited host range and lack of genetic diversity in influenza C, this form of influenza does not cause pandemics in humans.
Influenza A.
Swine influenza is caused by influenza A subtypes H1N1, H1N2, H2N3, H3N1, and H3N2. In pigs, four influenza A virus subtypes (H1N1, H1N2, H3N2 and H7N9) are the most common strains worldwide. In the United States, the H1N1 subtype was exclusively prevalent among swine populations before 1998. Since late August 1998, H3N2 subtypes have been isolated from pigs. As of 2004, H3N2 virus isolates in US swine and turkey stocks were triple reassortants, containing genes from human (HA, NA, and PB1), swine (NS, NP, and M), and avian (PB2 and PA) lineages. In August 2012, the Center for Disease Control and Prevention confirmed 145 human cases (113 in Indiana, 30 in Ohio, one in Hawaii and one in Illinois) of H3N2v since July 2012. The death of a 61-year-old Madison County, Ohio woman is the first in the USA associated with a new swine flu strain. She contracted the illness after having contact with hogs at the Ross County Fair.
Diagnosis.
The CDC recommends real-time PCR as the method of choice for diagnosing H1N1. The oral or nasal fluid collection and RNA virus-preserving filter-paper card is commercially available. This method allows a specific diagnosis of novel influenza (H1N1) as opposed to seasonal influenza. Near-patient point-of-care tests are in development.
Prevention.
Prevention of swine influenza has three components: prevention in pigs, prevention of transmission to humans, and prevention of its spread among humans. Proper handwashing techniques can prevent the virus from spreading. Individuals can prevent infection by not touching the eyes, nose, or mouth, distancing from others who display symptoms of the cold or flu, and avoiding contact with others when displaying symptoms.
Swine.
Methods of preventing the spread of influenza among swine include facility management, herd management, and vaccination (ATCvet code: QI09AA03 (WHO)). Because much of the illness and death associated with swine flu involves secondary infection by other pathogens, control strategies that rely on vaccination may be insufficient.
Control of swine influenza by vaccination has become more difficult in recent decades, as the evolution of the virus has resulted in inconsistent responses to traditional vaccines. Standard commercial swine flu vaccines are effective in controlling the infection when the virus strains match enough to have significant cross-protection, and custom (autogenous) vaccines made from the specific viruses isolated are created and used in the more difficult cases.
Present vaccination strategies for SIV control and prevention in swine farms typically include the use of one of several bivalent SIV vaccines commercially available in the United States. Of the 97 recent H3N2 isolates examined, only 41 isolates had strong serologic cross-reactions with antiserum to three commercial SIV vaccines. Since the protective ability of influenza vaccines depends primarily on the closeness of the match between the vaccine virus and the epidemic virus, the presence of nonreactive H3N2 SIV variants suggests current commercial vaccines might not effectively protect pigs from infection with a majority of H3N2 viruses. The United States Department of Agriculture researchers say while pig vaccination keeps pigs from getting sick, it does not block infection or shedding of the virus.
Facility management includes using disinfectants and ambient temperature to control viruses in the environment. They are unlikely to survive outside living cells for more than two weeks, except in cold (but above freezing) conditions, and are readily inactivated by disinfectants. Herd management includes not adding pigs carrying influenza to herds that have not been exposed to the virus. The virus survives in healthy carrier pigs for up to three months and can be recovered from them between outbreaks. Carrier pigs are usually responsible for the introduction of SIV into