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Confirmed H3N2v Cases At Jackson County Fair - Indiana Recombinomics Commentary 01:30
August 6, 2012

A common thread among those sick in Jackson County is that they had exhibited swine at the county fair or had visited the swine area, Bobb said. Cases started showing up July 26 and July 27 as the fair neared its end Saturday night.

Several patients were treated by an area doctor and the emergency room at Schneck Medical Center in Seymour, triggering submission of patient swabs for testing with the state health department, Bobb said.

The above comments describe symptomatic patients from the Jackson County Fair near Seymour, Indiana.  The Indiana State Department of Health announce one confirmed case on Thursday and at least three more on Friday, indicating patients who tested as “inconclusive” at ISDH were H3N2v confirmed by the CDC.

Friday the CDC released additional H3N2v sequences from recent cases linked to county in LaPorte and Jackson Counties in Indiana, Butler County in Ohio, as well as a Maui resident in Hawaii.  All of these sequences matched the novel sub-clade, which was first reported at a Mineral County day care center in West Virginia, which had an N2 gene which was distinct from the N2 gene in the first 10 H3N2v cases in 2011. 

All of the recent sequences are from July, 2012 collections, and the sequences from Indiana, Ohio, and Hawaii are more closely related to each than the earlier cases in West Virginia and Utah.  This close relationship, as well as the finding that all human cases since late 2011 have been from the novel sub-clade,, supports transmission and evolution in humans, not swine.

The first four sets of sequences were collected on July 16, 2012 and were from the LaPorte County fair.  Sequences from clones of from two of the cases, A/Indiana/07/2012 and A/Indiana/09/2012 were identical in all 8 gene segments.  Friday partial sequences were released from a sub-set of gene segments from the other two LaPorte cases, A/Indiana/06/2012 and A/Indiana/08/2012, and the partial sequences exactly matched the full sequences from the two earlier sets.
In contrast the fifth set of sequences A/Indiana/12/2012, was distinct and from a July 27 collection, matching the collection dates for cases at the Jackson County Fair. 

The release of sequences for the additional Jackson County cases will be of interest since symptomatic individuals in Jackson County have been noted for the past 6 weeks, raising the possibility of more diversity in Jackson County cases (as well previously for the three sets of sequences for Washington County Fair sequences from 2011, which were not epidemiologically linked.

Although the sequences from two different locations in Indiana were distinct, they were closely related to the July 27 collection from Ohio, A/Ohio/13/2012, and the July 12 collection from Hawaii, A/Hawaii/03/2012, signaling human transmission.

The sequences from the other Jackson County cases, as well as sequences from adjacent counties (Monroe, Washington, Jennings) will be of interest.

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