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United States H3N2 T128A Frequency Increases To 40%
Recombinomics Commentary 19:45
January 7, 2013

The CDC has released two more series of H3N2 sequences which included 21 US sequences, all of which had November collection dates.  14 sequences were from the Victoria/361 sub-clade including 13 of the 15 most recent isolates (collected between November 14-27.  Prior releases had identified two isolates which were designated as low reactors by the CDC.  One, A/Hawaii/29/2012, had HA L157S, which is in a region (positions 157-160) known to produces changes linked to immunological escape.  L157S was in the only Victoria/361 sequence collected prior to November 14, A/Pennsylvania/21/2012.  The other change, T128A, abolishes the glycosylation site at position 126, which was in A/Iowa/14/2012.  This change was in 6 of the 13 Victoria/361 sequences collected on November 14 or later (see list below).

The presence of T128A in 6 of the 15 most recent H3 sequences raises concerns that this change is leading to limited efficacy for the H3N2 vaccine and the rapid spread of H3N2 in the US and other countries in the northern hemisphere.  The presence of this change is also being reported by other agencies.  The first US H3N2 sequences of the current season released by the Navy surveillance system for Department of Defense personnel, A/Oklahoma/3059/2012, has T128A as do the first two sequences released by the Health Protection Agency in the UK.

The CDC reported two more pediatric deaths in the week 52 FluView, increasing the number of deaths reported in the past two weeks to 10, which brings the season total to 18.  Media reports have described 5 additional pediatric deaths, raising concerns that the number of cases reported by the CDC will continue to rise.  Similarly, the Pneumonia & Influenza death arte increased to 7.0 in the week 52 report, just shy of the epidemic threshold of 7.1%.

Although the CDC is testing a new vaccine target with L157S, A/Hawaii/22/2012, the most recent CDC suggests the loss of the glycosylation site due to T128A, is gaining significant traction.

Recent sequences with T128A
A/Washington/53/2012 83M   November 27
A/Florida/46/2012          66F   November 23
A/Alabama/24/2012      91M   November 19
A/Nevada/27/2012        16M   November 18
A/Montana/13/2012       26F   November 17
A/Minnesota/17/2012    75F   November 14

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