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Paradigm Shift Intervention Monitoring
Recent Human H3N2v Transmission
The above comments from the updated CDC factsheet on H3N2v in humans, “Fact Sheet: Protect Yourself Against H3N2v” acknowledges human to human transmission (H2H) in recent outbreaks, but claims that transmission has not continued beyond “one or two people”.
This claim lacks credibility.
The CDC has released sequences from seven July cases from four incidents in three states (a farmer in Maui, Hawaii – A/Hawaii/03/2012, four people linked to the LaPorte County Fair in Indiana (A/Indiana/06/2012, A/Indiana/07/2012, A/Indiana/08/2012, A/Indiana/08/2012), one case from the Jackson County Fair in Indiana (A/Indiana/12/2012), and one case from the Butler County Fair in Ohio (A/Ohio/13/2012).
All isolates matched the H3N2v isolated from two confirmed cases at a West Virginia day care center in late 2011 (A/West Virginia/06/2011 and A/West Virginia/07/2011) where 23 contacts of the index case had influenza-like illness (ILI) signaling significant H2H. This novel sub-clade was also in the first H3N2v case reported for 2012, A/Utah/10/2012, and has only been reported in two swine isolates collected prior to the July cases (A/swine/North Carolina/A01203272/2012 and A/swine/Indiana/A01203509/2012).
In contrast, the sub-clade matching the first 10 cases in 2011 has been identified in 26 swine isolates, including 12 isolates from 5 states (Illinois, Indiana, Iowa, Ohio, Texas), yet no human cases matching this earlier sub-clade have been reported in 2012. All cases, including those form July, have matched the West Virginia sub-clade, which was isolated from cases who had no swine exposure or contacts.
Thus, this novel sub-clade clear transmits H2H and transmitted well beyond “one or two people” at the day care center.
Moreover, the large number of cases at the Gallia Junoir County Fair in Ohio supports H2H transmission. An influenza A rapid test on 200 symptomatic cases identified 69 positives (sensitivity below 40%), and a sub-set was tested by the Ohio Department of Health (ODH) and the CDC and were confirmed to be H3N2v infected. The large number of cases, including the high frequency of false negatives, precluded a serious investigation of H2H transmission in the false negatives or additional symptomatic cases who were not tested.
Similarly, the H3N2v outbreak in Champaign County Ohio has led to a request that mild case not seek medical care, severely limiting information on the incidence and spread of H3N2v via H2H.
Detection of H2H is also limited by the CDC focus on symptomatic cases with swine contact. Off season mild ILI cases are not being tested, leading to unscientific claims that the human H3N2 cases are due to swine contact.
The CDC pseudoscience of H3N2v human transmission continues to be hazardous to the world’s health.