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CDC Confirms New trH3N2 Cases In Indiana and Maine
Recombinomics Commentary 18:45
November 4, 2011

Two human infections with novel influenza A viruses were detected in individuals from two states (Indiana and Maine). Both patients were infected with swine-origin influenza A (H3N2) viruses. One patient was hospitalized, but has now been discharged and both continue to recover from their illnesses. Both patients reported close contacts with pigs preceding their illness onset. There is no evidence of an epidemiological link between these two patients and no sustained human-to-human transmission of these viruses has been found in either state.

The above comments from the CDC’s week 43 FluView confirm the two additional trH3N2 cases represented by the sequences released by the CDC at GISAID earlier this week.  The above language on sustained human to human (H2H) is more scientifically accurate, noting that such transmission has not been found, in contrast to earlier statements claiming no sustained H2H.

The CDC has also issued another “Have You Heard?” which clearly states that the first Indiana case did not have a swine exposure, although his caretaker did (but neither the caretaker nor the associated swine were symptomatic).

Although the update does note the swine exposure for the two recent cases, there is no indication that any of the swine directly or indirectly associated with any 2011 trH3N2 cases were symptomatic or yielded any influenza (SOIV).

Thus, all 7 2011 trH3N2 cases have the same constellation of genes (and the CDC just released a partial NS sequence from A/Maine/07/2011, which is closely related to A/Maine/06/2011, strongly suggesting that all 8 gene segments from the two Maine cases are closely related).  In addition, the name of the isolate linked to the second Indiana case (59M), has been changed from A/Indiana/11/2011 to A/Indiana/10/2011.
The above comments also increase the number of hospitalized 2011 trH3N2 cases to 3 and at least one of the 4 cases not hospitalized did present at an Emergency Department with breathing difficulties.

As noted earlier, the presence of the same constellation of genes in all seven human cases, and the absence of this constellation in any swine isolates, strongly supports the emergence of a new human contagion in 2011

It is likely that this contagion will eventually be found in swine, as happened for H1N1pdm09 after efficient spread in humans, but to date there has been no evidence of this contagion in swine prior to the detection of this contagion in humans in late July, 2011.

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