Join Date: Aug 2008
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Henri Niman has been all over this, i'll post some of the recent Recombinomics commentaries.
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Two More trH3N2 Cases (PA & IN) Raise Pandemic Concerns
Recombinomics Commentary 01:15
September 2, 2011
Tomorrow’s MMWR (week 34) will report two more pandemic H3N2 cases (trH3N2). The cases in Indiana increase that state’s total to two, with both cases reported in a one month period. The H3 sequence, A/Indiana/08/2011, from the first case (1M) was closely related to the sequence from the Minnesota cluster, as well as cases in Wisconsin and Pennsylvania in 2010. The presence of similar sequence in human cases collected over a one year period raised concerns of human adaptation.
The latest cases raise the total for Pennsylvania to three and raise concerns that all three recent cases will have similar H3 sequences. The H3 sequence from Minnesota has been selected as a pandemic H3N2 vaccine target.
Release of sequences from the two recent cases, as well as information on the three recent cases would be useful. The CDC has not updated its website since January of this year, in spite of a confirmed cluster in MN, two confirmed cases in PA, and two confirmed cases in IN after the last update.
The reporting of three trH3N2 cases in the past month is without precedence.
---------- Post added at 10:09 PM ---------- Previous post was at 10:07 PM ----------
trH3N2 Cases In Indiana and Pennsylvania Match
Recombinomics Commentary 18:50
September 2, 2011
Novel influenza A virus infections***
PA (1), IN (1)
The above data is from today’s MMWR (week34), which cites two new trH3N2 infections in Pennsylvania and Indiana. The listing of two trH3N2 for the current week is without precedent. Prior cases (A/Kansas/13/2009, A/Iowa/16/2009, A/Minnesota/09/2010, A/Pennsylvania/40/2010, A/Wisconsin/12/2010, A/Pennsylvania/14/2010, A/Minnesota/11/2010, and A/Indiana/08/2011), were reported after the fact, and in many cases the reporting was months after the fact.
Two of the cases (WI/12/10 and PA/14/10) were announced in a WHO pager alert, which generated alarm in Europe. However, the WHO noted that the cases were isolated 6 weeks apart and the sequences were distinct and not from a common source and therefore the trH3N2 was not transmitting. However, PA/40/10 was from a patient infected within a week of WI/12/10 and the sequences were virtually identical, but PA/40/10 was not reported until 2011 and the close identity was not noted by the CDC. Thus, when the alert was announced there really were three cases (two in September and one in October) and the two September cases raised transmission concerns.
These concerns were increased when MN/11/10 was announced. The sequences from the November case was closely related to WI/12 and PA/40, and contacts of MN/11 were under investigation. In 2011 the daughter of the MN index case was H3N2 confirmed, and her lack of swine contact indicated she was infected by her father. Moreover, additional family members had been symptomatic, indicating MN/11 had spread. Concern regarding this spread increased when the CDC deposited sequencing indicating MN/11 had been selected as a vaccine target.
Concern was increased further when a new case was announced in the week 30 MMWR. That announcement was followed by the release of a set of sequences from Indiana, which was a reassortant that had acquired a pandemic H1N1 MP gene segment. Moreover, this isolate had an H3 that was closely related to the sequences from MN, PA, and WI raising concerns that this H3 was adapting to humans.
In spite of increased swine surveillance, which included release of HA sequences, most of the H3 sequences closely related to IN/08/11 were human trH3N2 isolates, and today’s MMWR cites another Indiana case as well as another Pennsylvania case.
Although the spike in cases in the past month is of more concern that the two cases cited in the 2010 pager alert, WHO and the CDC have not commented on these cases, or the selection of MN/11 as a pandemic vaccine target.
The relationship between the Indiana cases is unknown, which is also true for the recent Pennsylvania case.
More information on these cases is overdue.
BREAKING: Media reports indicate the two recent cases are children infected with trH3N2 with H1N1 MP.
---------- Post added at 10:37 PM ---------- Previous post was at 10:09 PM ----------
There are a lot more commentaries. The cases are still sporadic and it's back to the old game of finding long chains of infection but then again we watched H5N1 for years. The big clusters were a lot of cases (8 or so) but all a point source or one step of transfer in close contact.
Then pH1N1 jumped us. Off course both pH1N1 and trH3N2 are swine flu and both closer to human flu then bird flu so it should be easier for them to take of/adapt to humans. It's one to watch.