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Paradigm Shift Intervention Monitoring
Veterinarian With trH3N2 Not In Week 44 MMWR
The running total for 2011 (which is listed as 8 above) is confusing because the first two cases reported in 2011 were from infections in 2010. The first 2011 case was A/Pennsylvania/40/2010, which was from a Sept 6, 2010 infection, but reporting was delayed 5 months because the sample was initially designated seasonal H3N2. The release of the sequences were delayed another 6 week and quietly released on a Sunday at GISAID. All 8 gene segments were virtually identical to A/Wisconsin/12/2011, signaling human transmission.
The second case reported in 2011 was the daughter of the index case of the Minnesota cluster. The daughter had no swine contact and was acknowledged to represent human to human transmission from the index case, A/Minnesota/11/2010. Other family members were symptomatic by tested “inconclusive” strongly suggesting that more than the two confirmed family members were infected.
The first case reported in 2011 and also infected in 2011 was the child (2M) from Indiana, A/Indiana/08/2011,who also had no swine contact. His caretaker did have swine contact, but the caretaker and swine were asymptomatic.
The next three cases attended the Washington County fair (A/Pennsylvania/09/2011, A/Pennsylvania/10/2011, A/Pennsylvania/11/2011), but again no symptomatic swine were reported.
The seventh case reported in 2011 was the first case reported in Maine, A/Maine/06/2011, who also attended a fair (presumably the Cumberland County fair since the case was from Cumberland County) but the fair ended five days prior to symptoms, suggesting it was not the source of the infection. Moreover, symptomatic swine have not been reported at that fair.
The latest case reported in the week 44 MMWR is from Maine, and is likely the second case from Maine, A/Maine/07/2011, who lived near the first case and also attended an agricultural fair, which was also likely the Cumberland County fair, which was an unlikely source since the second case was identified in a sample collected 2 weeks after the first case.
The case that has not been reported in the CDC MMWR is the second case from Indiana, A/Indiana/10/2011, which was from a veterinarian.
However, the case was investigated by the Indiana Board of Animal Health and all contact swine were asymptomatic, again suggesting that the trH3N2 was not due to swine exposure.
All seven human cases have the same unique constellation of genes, which includes the M gene from H1N1pdm09 and this constellation has never been reported in swine.