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Epidemiologic Notes and Reports Outbreak of Influenza-Like Illness in a Tour Group -- Alaska

A 56-year-old Vermont resident began having influenza-like symptoms on August 25, while on a cruise ship off the coast of Alaska. Serum specimens collected from the patient showed a fourfold rise in hemagglutination inhibition titer, indicating infection with a contemporary strain of influenza A(H3N2) virus. The patient had been one member of a group of 35 (34 residents of Vermont, one from New Hampshire) that had departed for Alaska on August 15 and had spent the period August 22-26 on a cruise ship traveling along the Alaskan coast. Telephone interviews with all group members revealed that 19 (54%) had had a respiratory illness (fever or feverishness, and at least two of the symptoms of cough, coryza, sore throat) between August 23 and September 2; onset was August 25 for seven persons (37%). The mean age of the persons who became ill was 62 years, similar to that of the entire group. Anecdotal reports suggest high rates of respiratory symptoms among the approximately 600 other tourists on the vessel. Further serologic evidence for the occurrence of type A(H3N2) influenza infection among the tourists from Vermont is being sought. No other outbreaks of influenza-like illness or confirmed influenza infections have been reported in Alaska. Reported by: RP LaFiandra, MD, Addison County, Vermont; State Laboratory Directors and Epidemiologists, Alaska and Vermont. Div of Field Svcs, Epidemiology Program Office; Influenza Br, Div of Viral Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Although additional laboratory evidence of influenza infection is still being sought, it is likely that a cluster of influenza A(H3N2) infections occurred in the tour group from Vermont. Recent reports from the World Health Organization describe the circulation of type A(H3N2) strains in several Asian and Pacific nations from about April to September. Considering the large numbers of people traveling through Alaska who are residents of, or visitors from, countries of Asia and the Western Pacific, importation of the virus into Alaska in the late summer is to be expected.

The occurrence of an early outbreak of influenza A(H3N2), coupled with the lack of activity of type A(H3N2) virus in the United States last winter, suggests that this subtype will be at least partially responsible for the influenza activity of the coming season. Traditionally, type A(H3N2) viruses, in contrast to type A(H1N1) viruses, have spread to older persons (as in the Alaskan outbreak) and have been responsible for most mortality and excess hospitalizations, as well as causing increases in clinic visits and absenteeism from the workplace or classroom. Actions to reduce this impact are detailed in the recommendations of the Immunization Practices Advisory Committee (ACIP) (1) and in the proceedings of a recent symposium (2). In particular, these measures include vaccinating persons being treated for cardiopulmonary disease, residents of chronic-care institutions, persons over 64 years of age, and any other persons with underlying diseases that increase their likelihood of having complications from viral or secondary bacterial infections. In addition, physicians, nurses, or family members (including children) who might transmit infections to high-risk persons should be vaccinated.

Vaccine should be routinely provided during this season for the above high-risk persons and their close medical or family contacts.These persons should be actively identified and informed about the advisability of pre-winter vaccination against influenza. Pneumococcal vaccination history should also be determined for high-risk persons, and this vaccine should be administered simultaneously with influenza vaccine to persons who have not already received it. Booster doses of pneumococcal vaccine should not be given. For further information at the local level, contact state or county health departments, or the American Lung Association. References

  1. Immunization Practices Advisory Committee. Prevention and control of influenza. MMWR 1987;36:373-80,385-7.

  2. Douglas RG, ed. Proceedings of a symposium: prevention, management, and control of influenza: a mandate for the 1980s. Am J Med 1987;82(suppl 6A): 1-69.

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