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Paradigm Shift Intervention Monitoring
Issues trH3N2 Alert
For those under the age of 5 years of age, we are asking for enhanced surveillance. In an outbreak situation, all children 5 years old and under, who present to ER with any upper respiratory symptoms should be tested for influenza by nasopharyngeal swab and should be sent to the WV Office of Laboratory Services for PCR testing. Upper Respiratory symptoms may include ANY of the following:
· Fever (patient does not necessarily have to have a fever)
· Stuffy/runny nose
· Sore throat
· Shortness of breath.
Nasopharyngeal swabs should be sent to West Virginia Office of Laboratory Services (OLS) for (RT-PCR testing).
The above comments are from an alert issued by the West Virginia Department of Health and Human Research. Today the CDC released sequences from the second case (3M – A/West Virginia/07/2011), which was closely related to the first case (1M –A/West Virginia/06/2011), including the novel N2 gene. This constellation has never been reported in swine and the index case had no swine contact. More detail on these cases will be in an early release MMWR and the West Virginia website.
However, the 16 day gap between collection dates is the largest reported to date for epidemiologically linked cases, suggesting the number of cases with this novel trH3N2 is significantly higher than the two confirmed cases.
Moreover, the release of sequences from a novel trH1N1 case in Wisconsin, A/Wisconsin/28/2011, which also had an H1N1pdm09 MP (and PA) gene segments, as well as an H3N2pdm11 NP gene, indicates reassortment is widespread and transmission of novel influenza with an H1N1pdm09 E618D acquisition in PB1 or an H1N1pdm09 M gene leads to efficient transmission in humans.
The two cases in West Virginia represent the second confirmed cluster in recent weeks, which are in addition to the suspect trH1N2 cluster in Minnesota.
The co-circulation of multiple novel reassortants (excluding H1N1pdm09) representing three different serotypes (H1N1, H1N2, H3N2) and clusters involving three different constellations is without precedent, and highlight the need for aggressive surveillance and sequencing.