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Paradigm Shift Intervention Monitoring
Severe and Widespread trH3N2
The above comment from the September 5, 2011 Pennsylvania Department of Health press release regarding cases from Washington County raise concerns that one of the patients (9F), A/Pennsylvania/10/2011, has been “recovering” for more than six weeks.
Today the CDC released sequences from the three patients described in the above press release and one set of sequences came from a sample collected July 27, 2011. This collection date suggests this patient was infected well in advance of the August 13 start date of the Washington County Fair, raising concerns that trH3N2 infections are widespread and in the above case, severe.
These concerns were increased by the NA sequence,
A/Pennsylvania/09/2011, from a case (2F) from Schuylkill County, was at the fair on August 16. The sample tested was collected in August 20, 2011 and NA differences raise concerns that the patient was infected after she left the fair, and may have been infected in eastern Pennsylvania.
Moreover, the third sequence, A/Pennsylvania/11/2011, was collected August 25, five days after the end of the fair, suggesting this patient (also 9F) was also not infected at the fair.
These data suggest that the linkage to Washington County, and the associated agricultural fair, led to increased trH3N2 testing, which identified trH3N2 that had acquired a PB1 without E618D, and an M gene closely related to pandemic H1N1 isolates,which was critical for human transmission.
Thus, this novel constellation was widespread and found in Indiana, two Washington County, PA cases not linked to the fair, and a Schuylkill County case who visited the fair, but may have been infected in eastern Pennsylvania
Thus, the trH3N2 clade was widespread, and detected because of cases with perceived linkage to swine.
NOTE: The CDC has changed the collection date of A/Pennsylvania/10/2011 to August 26.