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Paradigm Shift Intervention Monitoring
Wisconsin Cases In Four Counties
As of 3:30 p.m. on August 30, 2012, there are 15 cases in Wisconsin.
The above comments from the Wisconsin Department of Human Services (DHS) press release (in red) describe 14 confirmed H3N2v cases from four agricultural fairs in four counties. The confirmed cases were increased to 15 (in blue) on the DHS H3N2v web page, which is likely due to testing of the 4 suspect cases linked to the Manitowoc fair as described in the Manitowoc County press release (in addition to 3 confirmed cases). Media reports increased the number of confirmed cases in Manitowoc to four and the description of the three remaining suspect cases suggests they will soon be added the confirmed cases.
Thus, there are at least 18 (15 confirmed) H3N2v cases in at least four counties in Wisconsin. The CDC has released one set of sequences, A/Wisconsin/22/2012, from an August 13 collection, suggesting it was linked to the State Fair in Milwaukee County, which ended August 12. The sequence was closely related to the 33 sets from recent cases in Hawaii, Indiana, Ohio, Maryland, Minnesota, and Pennsylvania signaling clonal expansion via sustained human transmission.
The linkage of these cases to agricultural fairs, live markets, or farms is due to heavily biases sample selection from off season ILI cases coupled with CDC documents and announcements highlighting the pseudo-linkage. 34 sets of sequences have been released from July and August cases and all were closely related in all 8 gene segments signaling clonal expansion.
Only two matching sequences have been reported in swine, while 24 sequences match the first 10 H3N2v cases in 2011. These sequences are in recent swine isolates from Ohio and Indiana, but none have produced any human cases since the Iowa cluster in November, 2011, which had no swine exposure. The absence of any recent human cases matching the earlier 2011 H3N2v cases indicates human, as well as the limited detection of the novel sub-clade first detected in at a West Virginia day care center, indicates the clonal expansion of the human sub-clade is due to human to human transmission.