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Both Maine trH3N2 Cases Linked To Fryeburg Fair
Recombinomics Commentary 13:00
November 16, 2011

• A male child became ill with influenza-like symptoms (fever, cough, chills and body aches) on October 22, 2011. The child continues to recover from his illness.
• The patient was seen by a local health care provider on October 24, 2011, where a respiratory specimen was collected and forwarded to the Maine Health and Environmental Testing Laboratory.
• The patient did not receive influenza antiviral medications.
• On October 28, 2011, diagnostic testing at the state laboratory was weakly positive for influenza A (H3), but negative for swine-origin influenza targets. The specimen was forwarded to CDC.
• On October 30, 2011, partial genome sequencing confirmed the virus as a swine-origin triple reassortant influenza A (H3N2) virus with the M gene from pH1N1.
• The patient reported multiple instances of close contact with pigs where sick pigs were present.
• No other ill persons have been identified at this time and no human-to-human transmission of this virus is suspected.

The above comments are a Louisiana Department of Health and Hospitals detailed description of the second Maine case (8M, A/Maine/07/2011) confirming that disease onset was two weeks after the first case from Maine (8M, A/Maine/06/2011), but the date of “close contact” with sick pig was conspicuously absent.

Recombinomics has discussed this case with the Maine CDC and Maine Department of Agriculture who have confirmed that both Maine cases attended the same agricultural fair and earlier reports indicated the first case attended a fair in the week prior to disease onset.  Two fairs in Maine match those dates (Cumberland fair from September 25 to October 1 and Fryeburg Fair from October 2 to October 9).  The contact for one of the cases was a pig scramble and both fairs had pig scrambles in October.  However the preponderance of evidence, indicates the swine “exposure” fair was the Fryeburg fair, which ended on October 9, well in advance of disease onset for the second Maine case, casting serious doubt on the fair exposure as a source for the trH3N2 infection..

Moreover, the sequences of the Maine isolates are virtually identical, casting doubt on a swine origin for either case.  Initial testing by the Maine Department of Agriculture of symptomatic swine from the fair have been negative for any SOIV, although the videographer filming the Fryeburg pig scramble was coughing throughout the 6:41 upload.

The absence of suspicion for human-to-human transmission may be linked to earlier comments from the Maine CDC who issued an advisory claiming that all prior 2011 trH3N2 cases had a swine exposure, which was not true for the first case in Indiana (2M, A/Indiana/08/2011) or the epidemiologist who indicated no thought has given for human to human transmission, which is not supported the identical constellation of genes in all seven human cases, which has not been reported in swine in Maine, Indiana, Pennsylvania, or anywhere in the world.

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