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CDC Update On trH3N2 Cases Increases Pandemic Concerns
Recombinomics Commentary 16:11
September 16, 2011

As a result of intensive surveillance after the identification of two cases of human infection with a novel influenza A virus, one in Indiana and one in Pennsylvania, reported in August MMWR, two additional human infections with novel influenza A virus were identified in Pennsylvania. Both patients were infected with swine-origin influenza A (H3N2) viruses, with illness onset dates of August 18 and August 21, 2011. One patient was hospitalized, but was discharged home and both patients have fully recovered. All three Pennsylvania patients reported contact with pigs at the same agricultural fair in the week preceding symptom onset and enhanced surveillance for human illness continues. Although these additional cases have been detected, exposure to pigs was reported in both cases and no evidence of ongoing transmission of this virus in the community has been identified.

The above comments from the week 36 FluView provide additional detail on the two most recent trH3N2 from Washington County.  Both patients (9F) report swine contact, but the disease onset dates, difference in the sequences from the Schuylkill patient (2F), and comments on a lack of any epidemiological linkages between the three confirmed cases, indicates the infections associated with the fair were due to independent events, as was the Indiana case (2M).  However, sequences from the two cases described above (A/Pennsylvania/10/2011 and A/Pennsylvania/11/2011) are virtually identical to the Indiana case (A/Indiana/08/2011) and these three isolates have the same constellation of genes as the patient from Schuylkill County (A/Pennsylvania/09/2011), which cludes the M gene segment, which is critical for efficient human transmission..

These four independent events, including the Indiana case who has no known swine contact, represent relatively severe cases.  Both of the earlier cases presented at a hospital Emergency Department, and one was hospitalized.  The above data indicates one of the more recent cases was also hospitalized, and the FluView is silent on the fourth case.  Therefore, at least 3 of the 4 cases either presented at an Emergency Department, was hospitalized, or both.  Thus, although all four cases have now recovered, they represent more severe cases and suggest dozens or hundreds of people have been trH3N2 infected, yet the vast majority of influenza A positive cases reported in weeks 35 and 36 have not been sub-typed. Two cases have been designated as unsubtypable and it is unclear if this is leading to sub-type designations.

The severity of these cases, coupled with limited sub-typing, continues to raise trH3N2 pandemic concerns.

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