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Paradigm Shift Intervention Monitoring
With No Swine Exposure
The Lake County General Health District has launched an investigation to determine if there was any contact with swine and to determine how exposure to the virus might have occurred. To this point, no contact with swine has been identified
Graham said the illness did not come from attendance at the Lake County Fair.
A public health investigation is being conducted to identify if there was any contact with sick animals or other persons who may have had influenza symptoms. The investigation so far has not demonstrated any connection to the Lake County Fair or any other Ohio Fair.
The above comments are from two media reports (in red and blue) on the recent confirmed H3N2v case from Lake County, Ohio. The absence of a swine exposure or contact would represent community transmission, which is unusual because most of the testing has targeted cases without swine contact. However, the large number of H3N2v cases in Ohio has increased awareness for influenza-like illness, which is starting to lead to more widespread testing, including cases without swine exposure..
The H3N2v cases in Ohio also led to testing of ILI cases in Ashland, Kentucky, which is in Boyd County, which is adjacent to Gallia County in Ohio and Mason County in West Virginia, where H3N2v cases have been confirmed.
Although Kentucky claimed that the ILI in children with no swine contact was due to seasonal H3N2, the recently released sequences from a sample submitted by the Kentucky Division of Laboratory Services in Frankfort was clearly from a H3N2v case and raises concerns that the 6 seasonal H3N2 cases claimed by Kentucky as well as the 188 seasonal H3N2 cases in weeks 31-33 reported by the CDC in the week 34 FluView represented sustained community transmission, which is strongly supported by the close relationship between the 41 July/August H3N2v sequences from cases identified from Hawaii to Maryland.
The detection of the same sub-clade in multiple cases with no swine contact has striking similarities to the initial cases identified in the 2009 pandemic. However, the CDC has been focused on the case with swine contact and has relied to the state testing with the CDC RT-PCR test to exclude cases from sequence analysis.
However, the Kentucky case (A/Kentucky/11/2012) has not been acknowledged by Kentucky or the CDC, in spite of collection almost a month ago (August 5) and deposited at GISAID on August 24, with a clear designation of H3N2v with an H1N1pdm09 M gene.