New influenza threats

Although we are now long past the typical time for outbreaks of seasonal influenza, there have been several reports recently of new influenza viruses ...

by Mary Govoni, CDA, RDA, RDH, MBA

Although we are now long past the typical time for outbreaks of seasonal influenza, there have been several reports recently of new influenza viruses that are causing concern for the Centers for Disease Control and Prevention.

These influenza viruses, H3N2, and H7N9, are of concern because they can cause serious respiratory illness in humans.

The H3N2 virus is one that normally occurs in pigs. The H3N2v is the "variant" form of the virus that can occur in humans, from exposure to infected pigs. This is not an occupational risk for dental professionals; however, during the summer months many people attend state and county fairs where exposures can take place.

It is believed that H3N2v is transmitted through droplet infection when a pig coughs or sneezes, or by touching surfaces that may have viruses on them and then touching the nose or mouth with infected hands. Once humans are infected, they can spread the virus to other humans.

If you are in attendance at a fair or a petting zoo, take care to avoid touching your face with your hands and use hand sanitizer frequently. If there are patients in your practice who show livestock at fairs, you may want to inform them of the risk of exposure to H3N2 and advise them to follow the same protocols.

When confirming patients, those that indicate that they have respiratory symptoms as well as a fever should be rescheduled to avoid risk of exposure to the team and other patients in the practice.

Other concerns addressed by the CDC include the fact that the H3N2 virus is spread more easily to humans than other swine influenza viruses. Children are much more susceptible to these viruses, since they have not developed natural immunity as many adults have.

The ever-present concern regarding any influenza viruses is that they are constantly changing or mutating. This may allow this particular virus to be transmitted directly from human to human.

The H7N9 influenza virus is an avian (bird) virus, which has been reported primarily in China and is associated with contact with poultry. There have been some reported cases where contact with poultry did not occur.

The CDC and Chinese authorities are closely watching this situation to determine whether any human-to-human transmissions have taken place, although none have been reported as this column goes to press. Several years ago, when the H5N1 virus was reported in China and a possible pandemic or global outbreak was feared, the CDC put into place protocols for emergency response planning for such an event. A summary of these protocols is available from the CDC website:

The CDC website is a great resource for all types of information regarding influenza. As I have mentioned in previous columns, the CDC also has an excellent resource page, CDC 24/7, with the latest information. The website address is The page can be downloaded to your smartphone, too.

Again, the avian or swine influenza viruses are not an occupational threat to dental health-care workers, except for exposure to infected patients and coworkers. But as we experience warm weather in the summer months, I see many team members becoming complacent with their respiratory protection while treating patients.

It is important to note that facemasks are disposable items and should be changed after every patient, or before if they become wet during a procedure. The mask should be positioned over the nose and mouth, although I frequently see team members with the mask positioned under the nose. This exposes the team member to any contaminants in the aerosol produced by the handpiece, triplex syringe, and ultrasonic scaler.

Many times team members have questions regarding the most appropriate type of facemask. My favorite resource for this information is from Crosstex. The company's educational resource, MaskEconomics, is a poster that explains the parameters for facemask selection, and can be accessed at

My best advice is to be diligent about keeping informed about influenza viruses. They can cause serious respiratory illness and even death in healthy people, as well as those who are medically complex. Stay safe and informed.

Mary Govoni, CDA, RDA, RDH, MBA, is the owner of Mary Govoni & Associates, a consulting company based in Michigan. She is a member of the Organization for Safety, Asepsis and Prevention. She can be contacted at or

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