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Is US CDC Playing A Shell Game With trH3N2 Unsubtypables?
Recombinomics Commentary 23:30
October 27, 2011

HETL detected a case of influenza A virus that was inconclusive during subtyping.
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 from the Maine CDC and the US CDC describe lab results expected for a novel influenza, like swine origin influenza virus (SOIV).  All confirmed human SOIV cases since 2009, when pandemic H1N1 (H1N1pdm09) jumped from swine to human, other than H1N1pmd09, have been H3N2 triple reassortants (trH3N2), leading to the federal CDC’s expectation that a sample that was influenza A positive and H1/H3 negative would be trH3N2 (and that expectation is similar to the situation at the start of the 2009 pandemic).

In 2009, state labs could not test for pandemic H1N1.  Samples could be tested for influenza A, and positives would be tested for seasonal H1 or seasonal H3.  Negative sub-typing results would lead to a shipment to the CDC for confirmation of swine H1, which was the only lab with the appropriate testing reagents.  The CDC was soon overwhelmed and distributed tests to state labs.  In addition, 3rd parties, such as Quest Diagnostics, developed a commercial test which would be applied to samples sent in by private physicians.

At this time, the status of swine H3 testing matches the situation in early 2009.  State labs identify samples that are influenza A positive, swine H1/seasonal H3 negative, and samples are sent to the CDC for confirmation, as described in the above comments regarding the latest confirmed trH3N2 case (8M), which produced the A/Maine/06/2011 trH3N2 sequence, which was closely related to the four prior trH3N2 confirmed cases (from Indiana and Pennsylvania).

Thus, far all four prior cases have had a loose swine “exposure” link, and all four cases have been promptly reported and associated sequences have been promptly released.  However, all of these cases fit the CDC narrative that the infections are somehow linked to swine, even though data supporting this linkage has not been presented.

The first case (2M) from Indiana had no direct linkage to swine.  His caretaker did have a swine link, but neither then caretaker nor the associated swine were symptomatic, and no infection of either the caretaker or swine has been reported.  Similarly, no swine at the Washington County fair, linked to the three Pennsylvania cases, or swine at the Cumberland County fair, linked to the Maine case, have been reported to be symptomatic or infected with any influenza.  Moreover, no swine anywhere in the world have been reported to have the constellation of flu genes seen in all five human cases, which includes the M gene from H1N1, which was critical for the jump of pandemic H1N1 from swine to humans.

These data strongly suggest that trH3N2 is transmitting human to human (H2H), but the CDC has not reported any cases that do not have a swine link, raising concerns that the reporting of unsubtypables in weekly FluView has striking parallels with a shell game which is being used to delay reporting of such cases.

These cases would destroy the CDC narrative of a swine link and therefore delayed as the lack of a swine link is under investigation. 

The first two trH3N2 cases reported in 2011 were 2010 cases that contradicted the CDC narrative, and these two cases were delayed 5 and 6 months.  The first case developed symptoms on Sept 6, prior to all other trH3N2 reported in late 2010.  However, the case and sequences, A/Pennsylvania/40/2010, were not announced until 2011 because the sample was initially classified as seasonal H3N2, and the trH3N2 was identified through routine surveillance which was delayed because of difficulties in growth the virus.  The sequence was virtually identical to A/Wisconsin/12/2010, which was due to an infection hundreds of miles away from the Pennsylvania case, but with a matching sequence, supporting H2H transmission.

Similarly, the second trH3N2 case reported in 2011 was another 2010 case that was delayed.  This case was the daughter of a Minnesota case, A/Minnesota/11/2010, who had no swine exposure.  She was lab confirmed serologically and announced in week 21, six months after infection.  This cluster was attributed to H2H transmission, the first such admission for trH3N2 cases (which probably extended to other symptomatic family members whose trH3N2 testing was “inconclusive”).

Thus, the first two trH3N2 reported in 2011 were delayed cases that strongly supported H2H transmission, which was acknowledged for the first confirmed case in 2011 who was infected in 2011.  That case was the Indiana case without a swine contact, but with a novel constellation of genes including the M gene from H1N1pdm09, which was followed by the 4 additional cases which all involved the same trH3N2 sub-clade.

The absence of cases without a swine contact raises concerns that the bizarre “now you see it” / “now you don’t” reporting of unsubtypables in the CDC FluView sub-typing table and figures represents changing criteria used to justify the withholding of trH3N2 cases without a known swine link, because these cases will signal the start of an H3N2 pandemic, and that data is being withheld until the absence of a swine link is clearer.

Only two of the five trH3N2 cases have been reported as unsubtypables (A/Pennsylvania/09/2011 in week 33 and A/Pennsylvania/10/2011 or A/Pennsylvania/11/2011 in week 34).  The other three cases, A/Indiana/08/2011 in week 30 and A/Maine/06/2011 in week 41, and one of the Pennsylvania cases in week 34 have never been listed in the sub-typable table, although the description of these cases clearly indicates they were influenza A positive, seasonal H3 or swine H1 negative, as reported for the two reported unsubtypables.  However, these two cases are listed in week 35 and 36 reports, removed from week 37 and 38 reports, listed again in week 39 and removed again in week 40.

Therefore, information on unreported trH3N2 under investigation should be released to end the shell game with unsubtypables, and trH3N2 PCR testing kits should be distributed to state labs immediately.

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