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CDC Releases Washington County PA trH3N2 Sequences
Recombinomics Commentary 19:45
September 7, 2011

The CDC is to be commended for the rapid release of sequences from the trH3N2 cluster in Washington County in southwestern Pennsylvania.  Full sequencing of all eight gene segments for all three isolates are not complete, but the sequences currently at GISAID, paint a very clear picture.  The three isolates were collected between July 27 and August 25, while the fair was only open between August 13-20 raising questions about the linkage to animals at the fair or the fair itself..

The colection dates suggest trH3N2 is widespread in the area, and the fair led to more frequent trH3N2 testing, which identified the three cases, which matched the case in Indiana, A/Indiana/08/2011.  The Indiana sequence was unusual because it was a reassortant that had acquired a PB1 gene without E618D, and it had an M gene from pandemic H1N1, which is critical for aerosolization and efficient human to human transmission.  All three isolates from Pennsylvania have this same constellation.

Moreover, if the case (9F) from July 27, A/Pennsylvania/10/2011, is “still recovering” as indicated in the Pennsylvania Health Department press release, she has been infected for 6 weeks.

Thus, the three sequences from Washington County represent independent infections, and linkage to the fair is tenuous at best.

The finding of the same rare trH3N2 constellation in cases in Indiana and Pennsylvania signal widespread trH3N2 transmission and a pandemic that is largely missed because most trH3N2 cases are classified as seasonal H3N2.

NOTE: CDC has changed collection date for Pennsylvania/10/2011 to August 26, six days after the end of the fair.

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