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Paradigm Shift Intervention Monitoring
Week 42 MMWR
Has Seven Novel Influenza Cases in 2011
The provisional table for notifiable diseases in the US for week 42 has added another novel influenza to the number reported in 2011, bringing the total to 7 (as seen above). Tomorrow’s report will be available later today, which will likely confirm that the new case is trH3N2, and if no new case is described in tomorrow’s FluView, it is likely that the 7th case reported in 2011 is the case (8M) in Maine (A/Maine/06/2011). The first two reported cases are from individuals infected in 2010.
The first showed symptoms on Sept 6, 2010, but was initially classified as a seasonal H3N2. Confirmation of trH3N2 was reported in February, 2011 (week 4) due to technical difficulties associated with growing / isolating the trH3N2 (5 months after the fact). The sequence, A/Pennsylvania/40/2011, is virtually identical to a Wisconsin case, A/Wisconsin/12/2011 with a disease onset date less than a week after the Pennsylvania case, providing strong evidence for human adaptation / transmission.
The second 2010 case reported in 2011 (week 21) was from the daughter of the Minnesota case (31M), A/Minnesota/11/2010. The daughter had no swine contact and the CDC has acknowledged human to human transmission as a likely explanation for the infection. Other family members were symptomatic, but serological testing was “inconclusive”. The H3 from the father was closely related to the above cases from Pennsylvania and Wisconsin, and the H3 and N2 from the Minnesota case is under development as a pandemic H3N2 vaccine target.
The five 2011 cases reported in 2011 are the case from Indiana, A/Indiana/08/2011, the three cases from Pennsylvania, A/Pennsylvania/09/2011, A/Pennsylvania/10/2011, A/Pennsylvania/11/2011, as well as the recent case in Maine, A/Maine/06/2011, All five of these cases have a novel constellation of genes (7 from trH3N2 and the M gene from H1N1pdm09), which has not been reported in swine. However, these five case fit the CDC of swine “exposure”, although the Indiana case has no direct link and has also been classified as a likely case of human to human transmission from his caretaker. However, the caretaker and associated swine a asymptomatic and no detection of SOIV infection has been reported.
Similarly, the Pennsylvania and Maine cases attended agricultural fairs (Washington County Fair in PA and Cumberland County Fair in ME), but no symptomatic swine have been reported and no SOIV have been detected in swine exhibited at either fair.
The identities in the 5 2011 human trH3N2 cases including an M gene from pandemic H1N1 (H1N1pdm09) strongly suggests that the cases are due to human transmission, but the CDC has not reported any 2011 cases without a loosely define “exposure”.
However, the bizarre reporting of unsubtypables in recent CDC FluViews, including the absence of the Maine case in last week’s report (week 41) raises concerns that the CDC is play a shell game with unsubtypables, including those that have been confirmed to be trH3N2 but are under epidemiological investigation which has delayed acknowledgement because these case have no identifiable swine exposure.