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Unsubtypables In United States Raise Pandemic Concerns
Influenza A, unsubtypeable† 10
Influenza A, seasonal (H1/H3) 6
†Subtype not determined by 2 assays, including 1 specific for pandemic (H1N1) 2009
The above data are from a CDC paper entitled “Fatal Infectious Diseases during Pandemic (H1N1) 2009 Outbreak” which looked at 450 fatal suspect pandemic H1N1 cases collected between April 29, 2009 and May 5, 2010. 250 cases tested negative for pandemic H1N1, but 10 of those cases (4% of thosae negative) were influenza A positive, but negative for H1N1pdm09 and seasonal H3, the common unsubtypable result commonly found for trH3N2 cases.
The paper does not provide additional detail, even though novel influenza is reportable under IHR regulations and trH3N2 cases in the United States were first detected in August, 2009, within the above time frame. Similarly, Pennsylvanai also reported unsubtypables at the end of 2010 and beginning of 2011, but these cases were not reported as unsubtypable in the CDC weekly FluView reports for that time period.
However, two of the recent trH3N2 cases (in weeks 33 and 34) have been reported as unsubtypables, although the reporting pattern has been bizarre with characteristics of a shell game. Although none of the prior confirmed trH3N2 cases have been fatal, almost 50% of these cases have been hospitalized.
Moreover, the CDC has released sequences on two more trH3N2 cases from samples collected in October, A/Indiana/11/2011 and A/Maine/07/2011, which match the earlier October case, A/Maine/06/2011, leaving little doubt that trH3N2 is currently transmitting human to human.
More detail on the fatal unsubtypables, including full sequences, would be useful.