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Swine H3N2 in Iowan Lacking Swine Exposure
Recombinomics Commentary 21:34
January 15, 2010

One case of human infection with a novel influenza A virus was reported by the Iowa Department of Public Health. The case patient had onset of symptoms in September 2009, but did not require hospitalization and has fully recovered. The virus was identified as swine influenza A (H3N2) and investigated in November 2009. No clear exposure to swine was identified, but no evidence of sustained human-to-human transmission with this virus was found.

The above comments from today's CDC weekly update (week 1) raises concerns because of the failure to identify a swine contact.  Although jumps from swine to human are common, a swine contact is usually identified and transmission to other humans is generally limited to family members.  Although the above comments describe an absence of evidence of sustained transmission, they do not address the presence or absence of flu symptoms in family members or contacts.

When swine H1N1 was discovered in southern California in April, there was no evidence of sustained transmission because infected family members had already recovered by the time the novel H1N1 was confirmed. 

Since swine H3N2 carries human H3 and human N2, transmission to humans is likely.  Moreover, the swine H3N2 would not be distinguished from contemporary seasonal H3N2, although seasonal H3N2 (and H1N1) appear to have been crowded out by swine H1N1.

More information on symptoms in family members and contacts, as well as a full set of sequences from the novel H3N2 isolate, (which is likely to be a triple reassortant) would be useful.

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