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Paradigm Shift Intervention Monitoring
H3N2pdm11Surveillance Raises Pandemic Concerns
The above comments from today’s CDC “Have You Heard” on the two novel human cases, trH1N2 (A/Minnesota/19/2011) and trH3N2 (A/West Virginia/06/2011) list possibilities for the increased detection of novel H1 and H3 triple reassortants, which ignores the sequence similarities between these isolates with the prior 2011 cases, H3N2pdm11. Other than the H1, all other gene segments in the H1N2 case are closely related to the 2010 human trH3N2 cases or the 2011 H3N2pdm11 cases. Similarly, the trH3N2 case matches the prior 2011 cases in all genes except the H2, which is closely related to swine H3N2 sequences.
Thus, the close relationship between these human cases and the prior cases indicates several different triple reassortants are circulating in humans, and the abysmal surveillance described above, which target one case per state, limits the true picture of the frequencies, which appear to be alarmingly high in US children under the age of 10.
Yesterday, the CDC released four more sequences from influenza A positive cases and all four were seasonal H3N2. However, the age was given for 3 of the 4 and all three were adults. In contrast, the two sets of sequences released today were from children under the age of 5 (the West Virginia case was 1F). These two cases raise the number sequenced under 10 influenza A cases to 14, and 11 of the 14 were closely related novel triple reassortants. Moreover, the five most recent cases had no swine exposure, and none of the prior 2011 cases have been linked to swine with confirmed SOIV infections.
Thus, the current rate of infection in US children under the age of 10 is 79%, based on public sequences, yet there has been no enhanced surveillance of this demographic.
The CDC continues to focus on targeting those with “swine exposure” and accidentally finding the widespread novel triple reassortants (trH1N2 and trH3N2), which now have been identified in 6 six states, in spite of abysmal surveillance.
An active surveillance including sequencing of influenza A positive cases under the age of 10 is long overdue.