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Paradigm Shift Intervention Monitoring
H3N2v Screening of US Travelers to UK
The above comments from the UK Health Protection Agency describe plans for screening ILI travelers from the US who have swine contact. This emphasis on swine contact, and heavily biased testing, is similar to the initial position of the CDC.
However, the size of the clusters as well as the limited detection of the novel H3N2v sub-clade in recent swine isolates (including 4 June isolates from Ohio which match the sub-clade found in 2011 human cases coupled with the absence of any 2012 human cases with the earlier sub-clade) has led to a recent change in the CDC position on screening to one of screening ILI cases without swine exposure. The broader screening has also been announced by the California Department of Public Health.
The earlier CDC screening was almost exclusively focused on ILI cases with swine exposure, leading to a pseudo-linkage that was not supported by the sub-clade distribution in swine, or the human adaptation of H3N2v, including NA N234D in the Laporte County, Indiana and Butler County, Ohio cases.
The HPA should modify its screening plans and risk assessment to reflect the clear indications demonstrated through analysis of the public swine and human H3N2v sequences.