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Gallia Ohio H3N2v Matches Jackson County Indiana
Recombinomics Commentary 19:30
September 3, 2012

The recently released CDC H3N2v sequences included those from an August 9 isolate from West Virginia, A/West Virginia/15/2012.  Although all of the July / August H3N2v (41 sets of sequences from Hawaii, Indiana, Ohio, Illinois, Kentucky, Maryland, Michigan, Minnesota, Pennsylvania, West Virginia, Wisconsin) are closely related to each and represent human to human clonal expansion of sequences first reported for the 2011 outbreak at the day care center in Mineral County, West Virginia ((A/West Virginia/06/2011 and A/West Virginia/07/2011)) and the first 2012 isolate, A/Utah/10/2012, the sequences cluster into sub-clades within the larger sub-clade.  The 2011 West Virginia cluster included 23 ILI cases in the index case contacts, which also had no swine contact or exposure.

West Virginia has reported three confirmed H3N2v cases and media reports indicate all three were from Mason County and attended the Gallia Junior County Fair in adjacent Gallia County in Ohio.  There the 2012 West Virginia sequence represents the first public sequences from the outbreak, where hundreds of attendees had influenza-like illness.  200 of the cases were tested in Ohio with an influenza A rapid test, and 69 were positive.  A subset of the positives were RT-PCR tested, and 12 confirmed cases from Gallia County have been reported by the Ohio Department of Health, which are in addition to the three cases reported by the West Virginia Department of Health and Human Resources.

The HA and NA sequences from A/West Virginia/15/2012 are identical to the first two sequences from Indiana (A/Indiana/12/2012 and A/Indiana/13/2012) following the four sequences from the Laporte outbreak (A/Indiana/06/2012, A/Indiana/07/2012, A/Indiana/08/2012, A/Indiana/09/2012).  The positive samples fropm LaPorte led to increased surveillance in Indiana.  However, prior to the LaPorte outbreak there was ILI in Jackson County, but these cases were not tested.  The first 11 confirmed cases in Indiana included 5 from LaPorte and 4 from Jackson County.  Thus, the West Virginia Gallia sequences match H3N2v in Jackson County, which was heterogeneous, signaling the prior human transmission.

In addition to the Gallia cases adjacent to Mason County, the Kentucky Ashland-Boyd reported ILI in children which were influenza A positive.  These cases were reported as seasonal H3N2 and a press release and health alert were issued.  However, the CDC released an H3N2v sequence, A/Kentucky/11/2012, which was collected August 5, consitent with the ILI cases, suggesting that the cases designated seasonal H3N2 based on the CDC RT-PCR test, were actually H3N2v cases, which is also likely true for many of the 188 seasonal H3N2 noted for weeks 31-33 in the week 34 FluView.  The Kentucky sequence was distinct from the West Virginia sequence from Gallia.

Detail on the Kentucky cases and sequence testing of the 188 H3N2 “seasonal” cases would be useful.  The Kentucky sequence, and additional cases mis-characterized as seasonal H3N2 would represent conclusive evidence of sustained community transmission of H3N2v.

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