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Cases Increase to 102 in 25 Counties
The above list represents the August 31 tally of H3N2v cases confirmed in Ohio by the Ohio Department of Health (ODH). The number of cases increased from 99 to 102, while the number of counties increased from 23 remained to 25. These short term increases signal increased testing, but also strongly suggests that many of the totals will represent serious undercounts.
The two new counties were Madison, which reported the first fatal H3N2v case (61F), and Lake which reported a case with no known swine exposure, which again signals community transmission. The CDC also released another Ohio sequence (A/Ohio/65/2012), wich was collected on August 5 and has NA N234D, which abolishes the glycosylation site. Sequences from West Virginia (A/West Virginia/15/2012) collected on August 9 and media reports indicate the 3 cases in Mason County, West Virginia attended the Gallia Junior County Fair. These sequences matched Indiana sequences. Moreover, sequences from Kentucky, A/Kentucky/11/2012, collected on August 5 were released, strongly suggesting these sequences were from a previously reported seasonal H3N2 case.
The 6 "seasonal" H3N2 cases in Ashland, Kentucky did not attend fairs in Ohio or West Virginia, but the tri-state cluster remains curious. West Virginia is also reporting "seasonal" H3 raising concerns that H3N2v cases in West Virgina and Kentury are being misdiagnosed because of limitations in the CDC RT-PCR test and expectations of seasonal H3N2 in cases with no swine exposure.
The continued increase in confirmed counties supports efficient human to human transmission, CDC qualifiers notwithstanding.