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Marin County California Issues H3N2v Alert
Recombinomics Commentary 20:30
January 6, 2012

Follow standard respiratory precautions when working with patents with ILI illness. Be prepared to screen patients for signs and symptoms of febrile respiratory illness at entry to your facility. If feasible, use separate waiting and exam rooms for possible flu patients, plan to offer surgical masks to symptomatic patients who are able to wear them, provide facial tissues and receptacles for their disposal, and provide hand hygiene products in waiting areas and examination rooms.

The above comments are from the Marin county Public Health Alert issued December 21, 2011, which followed a December 15 alert issued the California Department of Public Health due to a CDC request citing the West Virginia cluster involving 23/70 contacts with ILI.  The request for segregation of patients and use of masks is similar to guidelines for suspected H1N1pdm11 cases in 2009.

In addition to the CDC request for increased surveillance, an early release MMWR was issued on December 23, 2011, and reissued today.  The MMWR describes the West Virginia cluster as a case report, which indicates the virus was transmitting for a month at the Mineral county daycare facility.  Symptomatic contacts were cited, but the attack rate suggested by 23/70 cases of ILI in contacts of the index case.
Two sets of sequences from the cluster were released (A/West Virginia/06/2011 and A/West Virginia/07/2011), which had a novel N2 sequence, which had acquired tandem polymorphisms (L370S and S372L) from seasonal H3N2, signaling further human adaptation.

The large cluster suggests more cases and clusters will be reported this month.

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