FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 360:2616-2625 June 18, 2009 Number 25 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Perspective by Miller, M. A. Editorial by Baden, L. R. Editorial by Belshe, R. B. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear Related Article PubMed Citation

ABSTRACT

Background Triple-reassortant swine influenza A (H1) viruses — containing genes from avian, human, and swine influenza viruses — emerged and became enzootic among pig herds in North America during the late 1990s.

Methods We report the clinical features of the first 11 sporadic cases of infection of humans with triple-reassortant swine influenza A (H1) viruses reported to the Centers for Disease Control and Prevention, occurring from December 2005 through February 2009, until just before the current epidemic of swine-origin influenza A (H1N1) among humans. These data were obtained from routine national influenza surveillance reports and from joint case investigations by public and animal health agencies.

Results The median age of the 11 patients was 10 years (range, 16 months to 48 years), and 4 had underlying health conditions. Nine of the patients had had exposure to pigs, five through direct contact and four through visits to a location where pigs were present but without contact. In another patient, human-to-human transmission was suspected. The range of the incubation period, from the last known exposure to the onset of symptoms, was 3 to 9 days. Among the 10 patients with known clinical symptoms, symptoms included fever (in 90%), cough (in 100%), headache (in 60%), and diarrhea (in 30%). Complete blood counts were available for four patients, revealing leukopenia in two, lymphopenia in one, and thrombocytopenia in another. Four patients were hospitalized, two of whom underwent invasive mechanical ventilation. Four patients received oseltamivir, and all 11 recovered from their illness.

Conclusions From December 2005 until just before the current human epidemic of swine-origin influenza viruses, there was sporadic infection with triple-reassortant swine influenza A (H1) viruses in persons with exposure to pigs in the United States. Although all the patients recovered, severe illness of the lower respiratory tract and unusual influenza signs such as diarrhea were observed in some patients, including those who had been previously healthy.

Source Information

From the Influenza Division (V.S., C.B.B., T.M.U., B.S., A.B., X.X., S.L., L.V.G., V.D., R.J.G., A.K., J.S.B., L.F.), the Epidemic Intelligence Service Program (V.S., D.D.), and the Preventive Medicine Residency Program (V.S.), Centers for Disease Control and Prevention, Atlanta; the Iowa Department of Public Health, Des Moines (M.H., P.Q.); the Chicago Department of Public Health, Chicago (S.G., K.R.); the Michigan Department of Community Health, Lansing (S.V.); the Ohio Department of Health, Columbus (F.S.); the Texas Department of State Health Services, Austin (N.P.); the Minnesota Department of Health, St. Paul (K.M.); and the Illinois Department of Public Health, Springfield (C.C.).

This article (10.1056/NEJMoa0903812) was published on May 7, 2009, and was last updated on May 22, 2009, at NEJM.org.

Address reprint requests to Dr. Finelli at the Centers for Disease Control and Prevention, 1600 Clifton Rd., NE Mailstop A-32, Atlanta, GA 30333, or at lfinelli{at}cdc.gov.

Full Text of this Article

This article has been cited by other articles:

• Weingartl, H. M., Berhane, Y., Hisanaga, T., Neufeld, J., Kehler, H., Emburry-Hyatt, C., Hooper-McGreevy, K., Kasloff, S., Dalman, B., Bystrom, J., Alexandersen, S., Li, Y., Pasick, J. (2010). Genetic and Pathobiologic Characterization of Pandemic H1N1 2009 Influenza Viruses from a Naturally Infected Swine Herd. J. Virol. 84: 2245-2256 [Abstract] [Full Text]  
• Osterlund, P., Pirhonen, J., Ikonen, N., Ronkko, E., Strengell, M., Makela, S. M., Broman, M., Hamming, O. J., Hartmann, R., Ziegler, T., Julkunen, I. (2010). Pandemic H1N1 2009 Influenza A Virus Induces Weak Cytokine Responses in Human Macrophages and Dendritic Cells and Is Highly Sensitive to the Antiviral Actions of Interferons. J. Virol. 84: 1414-1422 [Abstract] [Full Text]  
• Holmes, E. C. (2010). Evolution in Health and Medicine Sackler Colloquium: The comparative genomics of viral emergence. Proc. Natl. Acad. Sci. USA 107: 1742-1746 [Abstract] [Full Text]  
• Chen, Z., Wang, W., Zhou, H., Suguitan, A. L. Jr., Shambaugh, C., Kim, L., Zhao, J., Kemble, G., Jin, H. (2010). Generation of Live Attenuated Novel Influenza Virus A/California/7/09 (H1N1) Vaccines with High Yield in Embryonated Chicken Eggs. J. Virol. 84: 44-51 [Abstract] [Full Text]  
• Sullivan, S. J., Jacobson, R. M., Dowdle, W. R., Poland, G. A. (2010). 2009 H1N1 Influenza. Mayo Clin Proc. 85: 64-76 [Abstract] [Full Text]  
• Bishop, J. F., Murnane, M. P., Owen, R. (2009). Australia's Winter with the 2009 Pandemic Influenza A (H1N1) Virus. NEJM 361: 2591-2594 [Full Text]  
• Uyeki, T. M., Sharma, A., Branda, J. A. (2009). Case 40-2009 -- A 29-Year-Old Man with Fever and Respiratory Failure. NEJM 361: 2558-2569 [Full Text]  
• LeBlanc, J. J., Li, Y., Bastien, N., Forward, K. R., Davidson, R. J., Hatchette, T. F. (2009). Switching Gears for an Influenza Pandemic: Validation of a Duplex Reverse Transcriptase PCR Assay for Simultaneous Detection and Confirmatory Identification of Pandemic (H1N1) 2009 Influenza Virus. J. Clin. Microbiol. 47: 3805-3813 [Abstract] [Full Text]  
• Sym, D., Patel, P. N, El-Chaar, G. M (2009). Seasonal, Avian, and Novel H1N1 Influenza: Prevention and Treatment Modalities. The Annals of Pharmacotherapy 43: 2001-2011 [Abstract] [Full Text]  
• Hancock, K., Veguilla, V., Lu, X., Zhong, W., Butler, E. N., Sun, H., Liu, F., Dong, L., DeVos, J. R., Gargiullo, P. M., Brammer, T. L., Cox, N. J., Tumpey, T. M., Katz, J. M. (2009). Cross-Reactive Antibody Responses to the 2009 Pandemic H1N1 Influenza Virus. NEJM 361: 1945-1952 [Abstract] [Full Text]  
• Faix, D. J., Sherman, S. S., Waterman, S. H. (2009). Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans. NEJM 361: 728-729 [Full Text]  
• Cui, J., Smith, T., Robbins, P. W., Samuelson, J. (2009). Darwinian selection for sites of Asn-linked glycosylation in phylogenetically disparate eukaryotes and viruses. Proc. Natl. Acad. Sci. USA 106: 13421-13426 [Abstract] [Full Text]  
• Munster, V. J., de Wit, E., van den Brand, J. M. A., Herfst, S., Schrauwen, E. J. A., Bestebroer, T. M., van de Vijver, D., Boucher, C. A., Koopmans, M., Rimmelzwaan, G. F., Kuiken, T., Osterhaus, A. D. M. E., Fouchier, R. A. M. (2009). Pathogenesis and Transmission of Swine-Origin 2009 A(H1N1) Influenza Virus in Ferrets. Science 325: 481-483 [Abstract] [Full Text]  
• Zimmer, S. M., Burke, D. S. (2009). Historical Perspective -- Emergence of Influenza A (H1N1) Viruses. NEJM 361: 279-285 [Full Text]  
• Garten, R. J., Davis, C. T., Russell, C. A., Shu, B., Lindstrom, S., Balish, A., Sessions, W. M., Xu, X., Skepner, E., Deyde, V., Okomo-Adhiambo, M., Gubareva, L., Barnes, J., Smith, C. B., Emery, S. L., Hillman, M. J., Rivailler, P., Smagala, J., de Graaf, M., Burke, D. F., Fouchier, R. A. M., Pappas, C., Alpuche-Aranda, C. M., Lopez-Gatell, H., Olivera, H., Lopez, I., Myers, C. A., Faix, D., Blair, P. J., Yu, C., Keene, K. M., Dotson, P. D. Jr., Boxrud, D., Sambol, A. R., Abid, S. H., St. George, K., Bannerman, T., Moore, A. L., Stringer, D. J., Blevins, P., Demmler-Harrison, G. J., Ginsberg, M., Kriner, P., Waterman, S., Smole, S., Guevara, H. F., Belongia, E. A., Clark, P. A., Beatrice, S. T., Donis, R., Katz, J., Finelli, L., Bridges, C. B., Shaw, M., Jernigan, D. B., Uyeki, T. M., Smith, D. J., Klimov, A. I., Cox, N. J. (2009). Antigenic and Genetic Characteristics of Swine-Origin 2009 A(H1N1) Influenza Viruses Circulating in Humans. Science 325: 197-201 [Abstract] [Full Text]  
• Trifonov, V., Khiabanian, H., Rabadan, R. (2009). Geographic Dependence, Surveillance, and Origins of the 2009 Influenza A (H1N1) Virus. NEJM 361: 115-119 [Full Text]  
• Belshe, R. B. (2009). Implications of the Emergence of a Novel H1 Influenza Virus. NEJM 360: 2667-2668 [Full Text]  
• Novel Swine-Origin Influenza A (H1N1) Virus Invest, (2009). Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans. NEJM 360: 2605-2615 [Abstract] [Full Text]