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H3N2v In Michigan With H1N1pdm09 PA & MP?
Recombinomics Commentary 21:45
August 29, 2013

Today, August 29, 2013, the Michigan Departments of Community Health (MDCH), and Agriculture and Rural Development (MDARD), along with the Berrien County Health Department (BCHD) have identified one case of an H3N2 variant (H3N2v) in a child who was a swine exhibitor at the recent Berrien County Youth Fair, which took place August 12-17, 2013.

The child, who was not hospitalized, is reported to have contracted H3N2v after exposure to swine at the fair. In addition, a sick pig from the fair tested positive for Influenza A H3N2 at the National Veterinary Services Laboratories in Ames, Iowa. MDCH, MDARD, and BCHD are working with the Berrien County Youth Fair (BCYF) board to reach out to swine exhibitors who attended the fair to identify additional illnesses.

The above comments from a MDCH press release describe the first H3N2v case in Michigan this year and the seventeenth 2013 case reported in the United States.  The three most recent cases prior to the above case were infected by H3N2 with H1N1pdm09 PA and MP genes.  The first sequence with this combination, A/Ohio/05/2013, was from an Ohio resident who had visited an agricultural fair in north western Virginia prior tp disease onset.  All prior human H3N2v had a signature change at position 145 (H3 numbering) which was N145K in the intial cases in Indiana and K145R in the subsequent case that were identified prior to the Ohio/ Virginia case.  A/Ohio/05/2013 had K145R.  However, the next two sequences, A/Illinois/03/2013 and A/Indiana/11/2013, had an H1N1pdm09 PA gene that exactly matched each other and differed from A/Ohio/05/2013 at two positions.  The Illinois and Indiana sequences had N145K.

The proximity of the Michigan fair to Indiana and Illinois locations (see map) suggests that the Michigan case will have N145K as well as H1N1pdm09 PA and MP genes.

Although the characterization sheets for the three prior cases with H1N1pdm09 PA clearly note that the cases have H1N1pdm09 MP and PA genes, the CDC has not addressed this development or the fact that none of the published swine H3N2v sequences match the most recent human sequences (the only closely related sequences are from an Illinois swine,
swine/Illinois/A01432795/2013, which had N145K and was closely related to the initial Indiana sequences, which also did not have H1N1pdm09 PA.

The CDC update on H3N2v spread at agricultural fairs notes that H3N2v can transmit from swine to humans as well as humans to swine, but the emphasis remains on transmission from swine to humans, even though swine sequences collected prior to the start of the agricultural fair season show discordance with subsequent human sequences.

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