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CDC Eliminates trH3N2 Unsubtypables
Recombinomics Commentary 19:30
September 27, 2011

The chart below is from the CDC’s week 37 FluView, which continues to show a low level of influenza activity, dominated by influenza A.  However, the two unsubtypables reported for weeks 33 and 34, reflecting two of the four reported trH3N2 cases, have been reclassified to seasonal H3N2, raising concerns that these adjustments will “hide” trH3N2 cases and lead to a gross under-representation in FluView reports.
Week 37 Subtypes
Prior trH3N2 cases were reported as seasonal H3N2 in FluView, although a small number were reported in the notifiable disease pages of MMWR as well as brief descriptions in FluView or summaries in MMWR.  About half of the reported trH3N2 cases have been hospitalized and all have had some kind of loose association with swine or swine locations.

The sequences from the2011 Indiana and Pennsylvania trH3N2 cases were virtually identical, and the Indiana case had no swine contact, although his caretaker did have contact with swine.  However, no human contacts of swine had flu symptoms and there were no reports of evidence of influenza infections.  Similarly, there were no reports of swine symptoms or infections in the Pennsylvania cases, raising concerns of human transmission, that are largely missed because of a lack of testing beyond serotyping that does not distinguish trH3N2 from H3N2.

Moreover, the “adjustment” that led to the removal of the “unsubtypables” may lower the number of positives as reflected in the table and chart.  One state, Minnesota, has reported a spike in ILI cases in the past two weeks, which are not reflected in the FluView figures.

Details on why the unsubtypables were classified as seasonal H3N2 would be useful.

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