Swine influenza
Swine influenza is an infection caused by any of several types of swine influenza viruses. Swine influenza virus or swine-origin influenza virus 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, 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.
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, 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. 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, 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.
The most common cause of death is respiratory failure. Other causes of death are pneumonia, high fever, dehydration, 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.