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Paradigm Shift Intervention Monitoring
Unsubtypable Not Reported In CDC FluView
Testing performed at Maine’s Health and Environmental Testing Laboratory on October 14, 2011 indicated a likely swine origin influenza A (H3N2) virus and this result was confirmed at CDC on October 16, 2011.
The above comments are from the week 41 report from the Maine Centers for Disease Control followed by the week 41 FluView from the CDC. Since the state lab cannot directly confirm trH3N2 cases, a sample that is influenza A positive, but negative for seasonal H3 and pandemic H1, leads the remark of a “likely swine origin influenza A (H3N2) virus”. The sample was then sent to the CDC for confirmation by a PCR test specific for trH3N2 and/or sequencing that can be performed on a clinical sample, which produced the published October 17 sequence, A/Maine/06/2011, from a sample collected on October 10, which is week 41.
However, although the trH3N2 case has been confirmed, the unsubtypable result generated by Maine’s Health and Environment Testing Laboratory is not listed in the unsubtypable column of the FluView week 41 sub-typing table. The absence of this unsubtypable extends the bizarre posting to subtype tables and figures in FluView. In weeks 30 (A/Indiana/08/2011), 33 (A/Pennsylvania/09/2011), and 34 (A/Pennsylvania/10/2011 and A/Pennsylvani/11/2011) samples from four additional trH3N2 cases were collected, but only two of the four (weeks 33 and 34) were represented in the in the table and figure, but these representations appeared in FluView reports for weeks 35 and 36, were removed in reports for week 37 and 38, reappeared in week 39, and removed again in week 40. The appearance and disappearances were without explanation and raise serious concerns about the representation of trH3N2 cases in FluView sub-typing tables.
Thus, only 2 of the 5 2011 trH3N2 have appeared as unsubtypables, and the representation of these two cases was inconsistent. Since all five were initially unsubtypable in state tests, it is unclear why all five didn not appear in the sub-typing table, which has an “unable to sub-type column” which was used to represent 2 of the 5 trH3N2 unsubtypables.
This inconsistency in reporting is similar to unsubtypables reported by Pennsylvania in late 2010 and early 2011. None of these case were listed as unsubtypable in FluView sub-type tables or figures, which has only reported two cases in the 2010/2011 season and no cases in the current 2011/2012 season.
An explanation for the bizarre and inconsistent sub-type reporting in the CDC FluView is long overdue.