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Paradigm Shift Intervention Monitoring
Illness In 23 Contacts of West Virginia H3N2v
The above comments are in the California Department of Public Health December 15 H3N2v advisory. The West Virginia cluster was described in the CDC early release MMWR, but the 23 ILI cases were not mentioned. Instead the report said there were several contacts of the index case, A/West Virginia/06/2011, which initially tested as negative. trH3N2 was isolated from a contact, A/West Virginia/07/2011, which initially tested as inconclusive and was reported as an influenza A case. The partial sequence of HA and NA were virtually identical to the index case, and both had a novel N2 that was easily distinguished from the first 10 cases in 2011 (H3N2pdm11).
Thus, the vast majority of cases at the day care center were not reported, and the two confirmed cases had serious testing issues. The numbers cited in the California advisory indicate the attack rate was high, and the transmission was sustained for almost a month, but the CDC maintains that there is no sustained or community transmission of H3N2v. None of the cluster members have reported contact with swine.
A pediatric case in Napa County, California has also tested positive for trH3N2 and is under investigation. Anecdotal reports indicate ILI is widespread in pediatric cases in northern California, but most are mild and not tested. As seen in the West Virginia cluster, testing is a serious issue, allowing the trH3n2 to silently spread.
An explosion of cases and clusters is expected this month.