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Paradigm Shift Intervention Monitoring
Today, Sunday, April 17, 2011
the CDC released a full set of sequences, A/Pennsylvania/40/2010, for a Pennsylvania H3N2 triple
reassortant (trH3N2) from a patient (3F) who developed symptoms
September 6, 2010. This case had been announced
February 5, 2011. The delay was attributed to difficulty in
isolating a virus from the patient.
Previously, WHO had issued a pager alert on two US trH3N2 cases from Illinois and Pennsylvania followed by the description of the sequences (A/Wisconsin/12/2010 and A/Pennsylvania/14/2010) from the patients (Wisconsin and Pennsylvania) who developed symptoms on September 8, 2011 and October 24, 2010, respectively. The notification was accompanied by a comment that the two sequences had differences, ruling out a common source.
However, the sequences released today from the other Pennsylvania case, , from a direct sequence of the sample indicated that the two cases, who developed symptoms two days apart, were infected by trH3N2 viruses that were virtually identical, signaling human to human transmission (see timeline here).
Although additional cases in Pennsylvania have not been reported, Pennsylvania has reported an unusually high number of unsubtypable cases in late 2010 and 2011 and has issued weekly reports to physicians raising awareness of the two prior Pennsylvania cases has created serious concerns that additional cases are under investigation and have not been announced.
An explanation of the weekly announcements and the high number of unsubtypable cases is long overdue.