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H3N2 Death Cluster In Manitoba Canada
Recombinomics Commentary 23:05
December 3, 2010

The fatalities are a 35-year-old woman from Garden Hill, and a man around 35 years old who got sick at Garden Hill but was a resident of Red Sucker Lake. The third woman is fighting for her life in hospital in Winnipeg.

And Grand Chief David Harper of Manitoba Keewatinowi Okimakanak said more than 20 other residents of the northern community are "coughing up blood."

The above comments describe an H3N2 outbreak in northern Manitoba.  Although the outbreak is being described as seasonal H3N2, the severity of the disease in previously healthy young adults raises concerns that the H3N2 detected is trH3N2.

trH3N2 has a seasonal H3 and N2 from the 1990’s but is a triple reassortant with an avian PB2 and PA, and a human PB1 from 1996.  The remaining gene segments are swine.  WHO recently issued a pager alert on two trH3N2 cases in the United States.  The sequences were recently released at GISAID by the CDC and the isolate from Wisconsin (A/Wisconsin/12/2010) and Pennsylvania (A/Pennsylvania/14/2010) are very closely related to each other, raising human transmission concerns since the two patients did not have contact with each other and were infected 6 weeks apart (see CDC update).

It is unusual for H3N2 to produce fatalities in previously healthy young adults.  Howver, the trH3N2 sequences have D225N in HA as well as 590S and 591R in PB2, changes that allow for adaptation in humans in the absence of E627K.  They also have E618D, which is a change found in virtually all pH1N1 sequences.  Thus, the trH3N2 could produce symptoms similar to those described above for the patients in Manitoba.

In addition to the outbreak in Manitoba, media reports describe an H3N2 outbreak in Mongolia that is also H3N2 and affecting children.  The media reports reference the trH3N2 cases in the US, but it is not clear if the Mongolia cases are seasonal H3N2 or trH3N2.

trH3N2 in Canada or Mongolia would signal a swine H3N2 pandemic.  More information on these cases as well as the fatal H3N2 outbreak in Akita, Japan would be useful.

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