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CDC Cedes Confimatory H3N2v Testing To State Labs
Recombinomics Commentary 11:30
August 10, 2012

The ODH lab will now be able to do final confirmation testing on H3N2v cases, as the Centers for Disease Control and Prevention has changed protocol. ODH will provide notice of any additional H3N2v human case confirmations on its website, and will send out a press release if any additional counties identify cases of H3N2v.

The above comments are from the August 8, 2012 press release from the Ohio Department of Health indicating final H3N2v confirmation will be done locally, indicating the CDC is overwhelmed and backlogged.
This became clear when details were released on two recent outbreaks in Ohio and Indiana.  Both involved more than 60 influenza A positive samples, which were likely generated via testing of more the 150 symptomatic individuals at each site, the Gallia Junior County fair in Green, Ohio and the Monroe County Fair in Bloomington, Indiana. The August 9 CDC telebriefing confirmed that all states would be allowed to confirm H3N2v in state labs.
It is likely that similar outbreaks were at additional locations in each state.  ODH reported 30 confirmed H3N2v cases in 5 counties, while ISDH reported 113 confirmed H3N2v cases in 16 counties.

The shifting of testing from the CDC to state labs has striking similarities with the 2009 H1N1v pandemic and it is likely that H3N2v will follow a similar path.  The large clusters being cited signal efficient H2H transmission, and the linkage to swine is largely linked to testing.

As the number of cases explodes, testing will be broadened.  The CDC has noted in recent releases that H3N2v can jump from swine to humans, but can also jump from humans to swine, which is the likely cause of the large number of H3N2v confirmed swine.  Detection of this novel H3N2v sub-clade was rare in swine prior to the July outbreaks in Indiana and Ohio.  It is likely that detection of H3N2v will increase at area fairs, which provide an ideal environment for H2S, S2H, H2H, and S2S transmission, leading to large H3N2v clusters involving hundreds of attendees.

The CDC also started citing limited H2H transmission, which will be increasingly obvious, and an H3N2 outbreak like the “flu” outbreak at Camp Sichma in Spey, New York would quickly capture the attention of the general public

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