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.

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This outbreak was linked to the hospital's potable water system and highlights the importance of maintaining a high index of suspicion for healthcare-associated LD, even in the setting of a long-term disinfection program.

Health care personnel (HCP) are at increased risk for infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), as a result of their exposure to patients or community contacts with COVID-19 (1,2). Since the first confirmed case of COVID-19 in Minnesota was reported on March 6, 2020, the Minnesota Department of Health (MDH) has required health care facilities* to report HCP † exposures to persons with confirmed COVID-19 for exposure risk assessment and to enroll HCP with higher-risk exposures into quarantine and symptom monitoring. During March 6-July 11, MDH and 1,217 partnering health care facilities assessed 21,406 HCP exposures; among these, 5,374 (25%) were classified as higher-risk § (3). Higher-risk exposures involved direct patient care (66%) and nonpatient care interactions (e.g., with coworkers and social and household contacts) (34%). Within 14 days following a higher-risk exposure, nearly one third (31%) of HCP who were enrolled in monitoring reported COVID-19-like symptoms, ¶ and more than one half (52%) of enrolled HCP with symptoms received positive * Health care facilities as defined by MDH include acute care hospitals, critical access hospitals, long-term acute care hospitals, skilled nursing facilities, assisted living facilities, group homes, adult foster care, treatment facilities, dialysis centers, outpatient clinics, dental clinics, home health care, and hospice. † HCP as defined by MDH include, but are not limited to, emergency medical service personnel, nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students and trainees, contractual staff members not employed by the health care facility, and persons not directly involved in patient care, but who could be exposed to infectious agents that can be transmitted in the health care setting (e.g., clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel). HCP does not include clinical laboratory personnel. § During February 8-May 18, 2020, CDC exposure risk assessment guidance included medium-and high-risk categories, with risk level based on PPE worn and type of potential contact with a person with confirmed COVID-19. On May 19, CDC's risk assessment was updated to include a single higher-risk exposure category to include close (within 6 feet), prolonged (≥15 minutes or of any duration during an aerosol-generating procedure) contact with a person with confirmed COVID

Influenza A virus infections commonly cause respiratory disease in swine and can be transmitted between people and pigs, with potentially novel strains introduced into herds and spilling back into the human population. The goals of this study were to characterize influenza infections in Minnesota pigs and assess biosecurity measures used by swine workers. Veterinarians submitting influenza-positive swine samples to the University of Minnesota Veterinary Diagnostic Laboratory between October 2007 and April 2009 were surveyed regarding disease-related information and biosecurity procedures at each farm. Influenza-positive samples were submitted year-round, peaking in spring and fall. H1N1 was the most commonly detected subtype (56%), followed by H3N2 (14%) and H1N2 (12%). Most positive submissions were associated with illness in growing pigs (median age 8.8 weeks, IQR 5-15). Median morbidity and mortality were 25% (IQR 10-48) and 2% (IQR 0.5-3.5), respectively. Vaccination of sows and growing pigs was conducted at 71% and 7.9% of the swine farms, respectively. Specialized footwear was reported as the most common form of protective equipment used by workers. Employee vaccination for seasonal influenza was 19%. The sow vaccination rate in this study is consistent with national data, although growing pig vaccination is lower than the national average. Seasonal and age trends identified here may provide diagnostic guidance when growing pigs experience respiratory disease. Inconsistent use of protective equipment and employee vaccination at swine farms indicates the need for further discussion and research of approaches to minimize interspecies influenza transmission on swine farms.

Abstract. We investigated whether Strongyloides infection remains endemic in rural Kentucky's Appalachian regions; 7 of 378 (1.9%) participants tested positive for Strongyloides antibodies. We identified no statistically significant association between a positive test and travel to a known endemic country (P = 0.58), indicating that transmission in rural Kentucky might be ongoing. BRIEF REPORTStrongyloides stercoralis infections occur in many countries around the world and are most prevalent in tropical environments with limited sanitation.

Ensuring the safety, health, and overall well-being of animals raised for food is both an ethical obligation and a critical component of providing safe food products. The use of antibiotics for maintaining animal health has come under scrutiny in recent years due to the rise of antibiotic resistance globally. Some U.S. producers, especially in the poultry industry, have responded by eliminating their antibiotic use. The number of animals raised without antibiotics (RWA) is growing in the U.S., but there are concerns that RWA practices might negatively impact animal health and welfare. Therefore, the objective of this study was to survey U.S. veterinarians and producers about their experiences and opinions regarding RWA production. Veterinarians, farmers, ranchers, producers, and other stakeholders involved in raising broilers, turkeys, swine, beef cattle or dairy cattle were surveyed. Of the 565 completed responses received, 442 self-reported as practicing veterinarians or producers. Just over half of respondents reported having past or current experience with RWA programs. The main indicated reasons for raising animals without antibiotics were market driven; switching to RWA production was less commonly made for health-related reasons, such as to reduce antibiotic resistance or to improve animal health and welfare. Although respondents felt that RWA production has negative impacts on animal health and welfare, they overwhelmingly (>70%) indicated that the customer (retailer/restaurant/food service) believes that animal and health welfare will be significantly improved. Veterinarians and producers indicated that RWA programs will increase production costs with questionable effect on meat, egg or dairy consumer demand. Many respondents felt that there are times when the RWA label takes priority over animal health and welfare. Respondents generally felt that there was a need for increased auditing/assessment of animal health and welfare in RWA systems.

has been receiving 100 specimens per week (50 from each of two clinical partners) with low cycle threshold (Ct) values for routine surveillance for SARS-CoV-2, the virus that causes COVID-19. On January 25, 2021, MDH identified the SARS-CoV-2 variant P.1 in one specimen through this surveillance system using whole genome sequencing, representing the first identified case of this variant in the United States. The P.1 variant was first identified in travelers from Brazil during routine airport screening in Tokyo, Japan, in early January 2021 (1). This variant has been associated with increased transmissibility (2), and there are concerns that mutations in the spike protein receptor-binding domain might disrupt both vaccine-induced and natural immunity (3,4). As of February 28, 2021, a total of 10 P.1 cases had been identified in the United States, including the two cases described in this report, followed by one case each in Alaska, Florida, Maryland, and Oklahoma (5). The first Minnesota P.1 variant case was identified in a person who became symptomatic in early January and was hospitalized for 9 days. During the case investigation, the person reported having traveled to southeastern Brazil within the 14 days before symptom onset. The patient's travel partner, who lived in the same household, also had symptoms of COVID-19 and received a positive SARS-CoV-2 test result after returning. The diagnostic specimen from this household contact was obtained for whole genome sequencing and confirmed to be the P.1 variant. The sequences from both patients were identical and had 15 of the 17 mutations associated with the P.1 variant, including the 10 S-gene mutations (2). The Minnesota patients were reinterviewed to obtain information on exposures and close contacts. † This activity was reviewed by CDC and conducted consistent with applicable federal law and policy. §