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Cases At Monroe County Fair - Indiana Recombinomics
Results from tests on several other people who had contact with Monroe County fair pigs — and had nasal swabs sent to the Indiana State Department of Health Laboratory — are still pending confirmation from the CDC, she said.
The above comments describe two confirmed H3N2v cases at the Monroe County Fair in Bloomington, Indiana, as well as ongoing testing of additional symptomatic cases. Earlier reports had noted that the swine barn had been closed after 75% of the pigs at the fair were symptomatic. Recent reports also indicated that 9 of the test swine were H3N2v confirmed.
The confirmed human cases increase concerns that the symptomatic cases in Jackson County may be contributing to the confirmed cases in central and southern Indiana. Although symptomatic cases were noted for six weeks, testing did not begin until four confirmed H3N2v cases were reported at the LaPorte County fair in northwestern Indiana. The first confirmed case after the LaPorte cases was from Jackson County, as noted in the August 2 press release by the Indiana State Department of Health (ISDH). Four confirmed cases were cited in the August 3 press release, raising the total to 4 or 5 from Jackson County. Moreover, a CIDRAP report cited three more confirmed cases in Indiana, which was in addition to the 11 cases cited in the August 3 press release.
It is unclear if the three additional cases included the two case described above, or were associated with more cases from Jackson County or other areas in Indiana. Symptomatic cases have also been reported at the Washington County fair, were some have tested as influenza A positive locally, and swabs have been sent to ISDH. Confirmed cases have also been reported in Tipton and Jennings counties, in addition to four or five confirmed cases in LaPorte.
Several of the recently confirmed cases in Indiana were “inconclusive” when tested by ISDH, but H3N2v confirmed by the CDC. Thus, it is likely that more symptomatic cases will be confirmed by the CDC, which issued a health alert on Friday, which is now available at the CDC website.
The alert cited 29 confirmed H3N2v cases since July, 2011, but the first 10 cases were from a sub-clade that is distinct from the 2012 cases. The current sub-clade was first noted in cases from a day care center in Mineral County, West Virginia. Two cases were confirmed, but the CDC sent out an alert to all fifty states since 23 contacts of the index case had influenza-like illness (ILI). This number was not cited in the MMWR on the West Virginia cluster, but an alert by the California Department of Public Health noted that 23 of the 70 contacts of the index case had ILI.
The first case in 2012 was from Utah, A/Utah/10/2012, and the sequence, like all subsequent human H3N2v cases, was related to the novel sub-clade in West Virginia, where there was no swine contact or exposure in the two confirmed cases, (A/West Virginia/06/2011 and A/West Virginia/07/2011).
The CDC has released sequences from the four cases in LaPorte. Full sequences from two of the cases, A/Indiana/07/2012 and A/Indiana/09/2012 were closely related to the sequences from West Virginia and Utah, but were identical to each other as well as partial sequences from the other two confirmed cases, A/Indiana/06/2012 and A/Indiana/08/2012.
The CDC also released sequences from the first confirmed case in Jackson County, A/Indiana/12/2012, which was related but distinct from the LaPorte sequences. Similarly, sequences, A/Ohio/13/2012, from one of the ten confirmed Butler County cases (from Hamilton, Ohio) were also related but distinct, which was also true for a recent case from Maui, Hawaii, A/Hawaii/13/2012.
However, the recent sequences from Laporte and Jackson counties in Indiana, Butler County in Ohio, and Maui, Hawaii were more closely related to each other than the earlier cases in West Virginia and Utah, supporting human evolution, since only two cases of this novel sub-clade were found in swine (in North Carolina and Indiana), in samples collected prior to the LaPorte cluster.