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Paradigm Shift Intervention Monitoring
Case In Maine Matches Indiana and Pennsylvania
The Indiana case had no swine contact, and the latest comment from the CDC, in week 40 FluView, only states that the three Pennsylvania cases attended a county fair that exhibited swine. There was no statement claiming swine contact (and there have been no reports of symptomatic swine at the Washington County fair and no reports of any influenza infections in swine).
In contrast, all five human cases in 2011 have the identical constellation of flu genes including a PB1 that lacks E618D, an NA that is similar to A/Pennsylvania/14/2010, and an MP that matches pandemic H1N1.
The CDC claim of no sustained transmission merely reflects the limitations in the CDC sample collections and testing, which failed to find a source for any of the cases, including the caretaker of the Indiana case. The pseudo-linkage to swine drives trH3N2 testing of cases infected prior to the start of the flu season. Details on the present case have not been released, but in contrast to earlier locations for 2011 trH3N2 cases in states that have high levels of swine, the location of this case, Maine, is not noted for swine farms or fairs.
The circumstances associated with the detection of the current case in unclear, but the bizarre reporting on unsubtypables raises concerns that testing for influenza A and/or seasonal H3 is a less than ideal approach for detecting human trH3N2 cases.
The CDC should distribute swine H3 PCR kits to the state labs to determine the true level of human trH3N2 infections and transmission in the United States.