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Paradigm Shift Intervention Monitoring
Cluster Due To H3N2 Drift Variant
Three of the samples (A/Maryland/04/2012, A/Maryland/05/2012, A/Maryland/06/2012) were from March 5 collections, the date of death for two of the siblings. The other two, A/Maryland/08/2012 and A/Maryland/09/2012, were from collections on February 21 and February 20 respectively. Although the ages and gender of the index case and three children involved in the Maryland death cluster have been cited in media reports, the CDC withheld the age and gender for all five sequences.
Thus, the assignment of each of the five samples was not possible from the public data released by the CDC. However, all five H3 sequences were virtually identical and related to the drift variant, A/Brisbane/299/2011, which has S199A, as noted for prior sequences designated as low reactors by the CDC.
A reassortant of A/Brisbane/299/2011 (designated A/Brisbane/299/2011 X-215) has been generated as a potential H3N2 vaccine target because it is a variant that produces a low reaction when tested against the current vaccine, which is directed against A/Perth/16/2009.
Thus, the sequence data confirmed that the Maryland cluster were from a drift variant and were unlikely to react well with the current vaccine, in contrast to the CDC comments and internet rumor.