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Paradigm Shift Intervention Monitoring
Novel Under 10
Flu Cases In United States Approach 100%
The new MMWR release provides additional data on the failure of the newly approved CDC PCR, casts additional doubt on the “swine exposure” linkage for the cases identified in the off season (A/Indiana/08/2011, A/Pennsylvania/09/2011, A/Pennsylvania/10/2011, A/Pennsylvania/11/2011) or initial cases at the beginning of the 2011/2012 season (A/Maine/06/2011 and A/Main/07/2011). The data highlight the need for sequence confirmation, which has led to requests for new samples from all states, and new guidance on case definitions, sample collection, and 24 hour reporting.
Although the early release MMWR clearly signals the CDC acknowledgment that a pandemic has begun, the limited testing has kept this pandemic largely hidden since the first cases in July and August. This pandemic has largely involved two different constellations of H3N2 triple reassortants in cases under the age of 10, but trH1N1 and trH1N2 cases have also been recently reported, and all 20 novel cases reported in 2010 or 2011 have had H1N1pdm09 E618D in PB1 or an H1N1pdm09 M gene.
Thus, in one sense the alarming evolution leading to the explosion of novel cases is an extension of the 2009 pandemic, but the 20 cases involve five different constellations and three different serotypes, including four different serotypes reported in the past month.
Below are the US under 10 cases represented by the public sequences for the 2011/2012 season.
Novel cases in bold:
A/West Virginia/07/2011 3M trH3N2 12/07
A/West Virginia/06/2011 1F trH3N2 11/21
A/Iowa/09/2011 2M H3N2pdm11 11/14
A/Iowa/08/2011 1M H3N2pdm11 11/14
A/Iowa/07/2011 3F H3N2pdm11 11/14
A/Minnesota/19/2011 1F trH1N2 11/04
A/Maine/07/2011 8M H3N2pdm11 10/24
A/Maine/06/2011 8M H3N2pdm11 10/10
A/Indiana/09/2011 1M H3N2 10/02