A Multisite, Prospective, One Health Investigation of Zoonotic Swine Influenza Among 4-H Members and Their Swine at Agricultural Fairs in Pennsylvani

The unique animal-human interface created in an agricultural fair setting is a potential hot-spot for transmission of zoonotic influenza. Swine have the ability to undergo infection from swine, human, and avian influenza viruses, thus making them a likely source for emergent influenza viruses capable of spreading in humans. Since 2005, 373 cases of variant influenza (swine origin influenza virus that infects humans) have been reported in the United States. Swine exhibitors, such as those from 4-H and their swine, may be responsible for outbreaks of zoonotic influenza (e.g. H3N2v) at agricultural fairs. Although youth who exhibit swine at fairs are recognized for their risk of contracting and/or introducing zoonotic influenza to the general public, we know very little about their farm biosecurity risks or knowledge and behaviors regarding zoonotic influenza.;A multi-site, prospective, One Health investigation that assessed interactions between humans, animals, and the environment was conducted. This study used a convenience sample of 138 4-H members and leaders of 4-H groups attending five county fairs in western, southcentral, and south-eastern Pennsylvania during the summer of 2014. The first aim of the present study was to assess the incidence of influenza like illness in 4-H members and their swine through fair and follow-up interviews and collection of nasal swab samples (human and swine) and saliva samples (swine); swine samples were tested for influenza virus using RT-PCR and virus isolation. The second aim was to quantify interrelated risk factors from multiple levels including: fair environment, farm environment, and individual level knowledge and behaviors. Observational assessments at each fair were used to characterize the fair environment. Biosecurity risks for 4-H members were assessed in four domains: housing, transportation/sharing, animal, and human through three surveys conducted prior to, during and after the fair.;No ILI or influenza virus was detected in humans or swine. Fair environment assessments revealed that the availability of hand sanitization facilities and related informational signage was poor across most fairs. Assessment of farm-level biosecurity risk in the housing and transportation/sharing domains found that almost all participants' swine (91.3%) were kept on a farm with other types of livestock, 17% indicated they house their swine on a farm with commercial livestock, and 16% transported their swine to other shows where contact with other swine increases risk for influenza infection. Among the animal biosecurity risk factors, poor quarantine procedures were indicated in 73% of respondents who traveled to/exhibited at another event. As belief in biosecurity importance increased, the odds of quarantining new or returning animals on the farm increased (OR:2.2; CI:1.0-4.8). Knowledge summary scores from the human biosecurity domain were low, with the mean score below the 50% correct bench-mark. Approximately 27% of the participants did not know or did not believe humans could contract disease from animals. 4-H members exhibited moderate risk in personal protective equipment (PPE) use as evident by a mean PPE use score of 7.1 (range: 1-15; low-high risk). For every one point increase in the knowledge summary score there was a 0.4 point (CI: - 0.7 - -0.05) decrease in the PPE risk score. 4-H member social networks did not appear to be highly sex-assortative, but did assort by age and on average, participants who shared their tools had much higher degree or number of connections than the participants who did not share their tools.