• FluTrackers.com Inc. does not provide medical advice. Information on this web site is collected from various internet resources, and the FluTrackers board of directors makes no warranty to the safety, efficacy, correctness or completeness of the information posted on this site by any author or poster. The information collated here is for instructional and/or discussion purposes only and is NOT intended to diagnose or treat any disease, illness, or other medical condition. Every individual reader or poster should seek advice from their personal physician/healthcare practitioner before considering or using any interventions that are discussed on this website. By continuing to access this website you agree to consult your personal physican before using any interventions posted on this website, and you agree to hold harmless FluTrackers.com Inc., the board of directors, the members, and all authors and posters for any effects from use of any medication, supplement, vitamin or other substance, device, intervention, etc. mentioned in posts on this website, or other internet venues referenced in posts on this website.
  • We are not asking for any donations. Do not donate to any entity who says they are raising funds for us.

Is H2H spread of H3N2v occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Here's the Indiana case... he was ill on July 23. Notice the specimen was forwarded but it doesn't say from where.

Patient A. On August 17, 2011, CDC was notified by the Indiana State Department of Health Laboratories of a suspected case of swine-origin influenza A (H3N2) infection in a boy aged <5 years. The boy, who had received influenza vaccine in September 2010, experienced onset of fever, cough, shortness of breath, diarrhea, and sore throat on July 23, 2011. He was brought to a local emergency department (ED) where a respiratory specimen later tested positive for influenza A (H3). The boy was discharged home, but was not treated with influenza antiviral medications. He has multiple chronic health conditions, returned to the ED on July 24, 2011, and was hospitalized for treatment of those health problems, which had worsened. The boy was discharged home on July 27, 2011, and has since recovered from this illness. As part of routine CDC-supported influenza surveillance, the respiratory specimen collected on July 24, 2011, was forwarded to the Indiana State Department of Health Laboratories, where polymerase chain reaction (PCR) testing identified a suspect swine-origin influenza A (H3N2) virus on August 17, 2011. The specimen was forwarded to CDC where the findings were confirmed through genome sequencing on August 19, 2011.

No direct exposure to swine was identified for this child; however, a caretaker reported direct contact with asymptomatic swine in the weeks before the boy's illness onset and provided care to the child 2 days before illness onset. No respiratory illness was identified in any of the child's family or close contacts, the boy's caretaker, or in the family or contacts of the caretaker.

So why does GISAID say the collection was July 27? It almost looks like some of the GISAID sequences might belong to still unannounced cases...
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

What does this mean for this year?s flu vaccines? Will the current vaccine cover both seasonal flu and this new strain of flu?

The 2011‐2012 vaccine is the same as last year, covering two strains of influenza A (pandemic H1N1 and a H3N2 strain that has been circulating for a few years now) as well as a strain of influenza B. It is too early to tell whether or not this new strain will even need vaccination.

Should we be concerned that a flu pandemic is pending?

A pandemic is a global outbreak of disease. A flu pandemic happens when a new strain of the flu virus appears for which people have little or no immunity. As a result, it spreads easily from person to person around the world, causing widespread illness and death.

Currently, we don?t have any evidence to support that this novel influenza A virus will lead to a pandemic, as we haven?t yet been able to prove that it is being transmitted from human to human. As with any new influenza A virus, public health officials are working to learn more about the source of this particular strain and to determine how/if it can be spread from person to person.

About the Investigation in Pennsylvania

We?re working with the CDC on this investigation, with assistance from the Pennsylvania Department of Agriculture. Their international influenza experts are working closely with state and local investigators, and the CDC?s laboratory is providing very specialized analysis of the virus. The investigation is focused on determining patterns of influenza‐like illness, doing laboratory testing, increasing surveillance and alerting health care providers to this case to assist with reporting efforts. Together, we are continuing to investigate the origin of this influenza strain and whether or not human‐to‐human transmission is occurring.

http://www.flutrackers.com/forum/showthread.php?p=420908#post420908
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Alert,
I see from reports that they do seem to be really sure about the fair and dates; so I don't have any answer regarding the collection dates at GISAID.

From the news forum:
Harrisburg ? The Pennsylvania departments of Health and Agriculture today announced three cases of a novel influenza A virus have been identified, and are now linked to an agricultural fair in southwestern Pennsylvania.
The first individual to become ill, announced on Friday, Sept. 2, has fully recovered from the illness. Two other individuals, confirmed ill over the weekend, are recovering. All three are children who reported attending the Washington County Agricultural Fair the week of Aug. 13-20, 2011.
http://www.pa.gov/portal/server.pt?open=18&objID=1166252&mode=2
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

As noted elsewhere, there are two isolates from this individual. This clears up a bit of the confusion on this case.

EPI_ISL_95264
Collection date: 7-24
Location: Indiana
Passage history: C1
Submitted: 8-25
Modified: 9-07

EPI_ISL_96015
Collection date: 7-27
Location: Pennsylvania
Passage history: original
Submitted: 9-07
Modified: 9-07
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

GISAID have updated their EpiFlu database to note the location for EPI_ISL_96015 as Indiana and add EPI_ISL_95264.

Both isolates EPI_ISL_96015 and EPI_ISL_95264 have the CDC ID number of 2011814862.
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Thanks Sharon.

The patient information sheet for Pa/10 has also been modified. The collection date now reads 8-26.
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Wow. Can't believe I had both errors exactly right. So there are now five sequences at GISAID belonging to the four cases, and we appear to be consistent with the MMWR now.

I am updating my above post.
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Wow. Can't believe I had both errors exactly right.

:tiphat: :)

Yes, 5 samples for the 4 patients.

I apologize for adding confusion with my speculations. It's a relief to know that the 3 were linked to the fair.
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

And I don't have a problem with August 25 and 26 sample dates for two of the cases. If one figures a few days incubation period, plus maybe a few days to decide you are sick enough to go to the hospital and then maybe testing around day 3 of hospitalization, it could easily be even 10-14 days from exposure to sample.
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

I'm still a bit confused after reading through the latest posts. So, a sample was collected on 7/24 from a child in IN and then a second sample was collected from the same child in PA on 7/27?
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

I'm still a bit confused after reading through the latest posts. So, a sample was collected on 7/24 from a child in IN and then a second sample was collected from the same child in PA on 7/27?

No. PA was a reporting error. The child was in Indiana the whole time, and both samples were taken in IN.

The PA 7/27 sample was also a reporting error; it has been corrected to 8/26.
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Got it. Thanks.
No. PA was a reporting error. The child was in Indiana the whole time, and both samples were taken in IN.

The PA 7/27 sample was also a reporting error; it has been corrected to 8/26.
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

<TABLE style="WIDTH: 100%"><TBODY><TR><TD width="50%">Originally Published: 9/13/2011 </TD><TD width="50%" align=right><SCRIPT type=text/javascript src="http://static.ak.fbcdn.net/connect.php/js/FB.Share"></SCRIPT>



</TD><TD vAlign=top rowSpan=3 align=right></TD></TR><TR><TD colSpan=2>Novel virus strain in state is not outbreak, officials say</B>

Excerpt:

</TD></TR></TBODY></TABLE></B>
"Everything that has come out so far suggests these are not easily transmittable," said Dr. Robert S. Jones, chief of infectious diseases at both St. Joseph Medical Center and Reading Hospital. "People shouldn't panic about that strain."
...
An investigation has not yet uncovered how the illness was transmitted.

This year's flu vaccine does not protect against this novel strain, state health officials said.

But the strain does respond to treatment with the antiviral drugs oseltamivir and zanamivir, which are used to treat infection with human seasonal viruses.

Full text:
http://readingeagle.com/article.aspx?id=331962
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

I suppose we'll know soon enough, but the circumstantial evidence suggests H2H transmission for the following reasons.

1) A randomly selected sample collected during routine surveillance last season was sent to CDC for sequencing that turned out to be trH3N2. If only a few cases were circulating strictly from swine to human transmission, it would be one heck of a coincidence that one of those few would be randomly selected for sequencing out of thousands of samples available.

2) I don't know what the typical ratio of confirmed flu cases to actual infections is, but if three cases of trH3N2 were detected in kids who attended the fair, it is likely that 10x or even 100x more people contracted the virus without seeking medical help or without being tested.

3) My understanding is that the Indiana case is so genetically similar to the PA cases, that either pigs with the same strain were transported between the states, the virus mutated along a nearly identical path in two separate swine populations, or it is transmitting H2H.

The question now I think is how efficiently can it transmit H2H and will it be as severe as pH1N1 was in 2009, or will we have sufficient herd immunity from exposure to prior H3N2 viruses to keep it from spreadly widely.

<"Everything that has come out so far suggests these are not easily transmittable," said Dr. Robert S. Jones, chief of infectious diseases at both St. Joseph Medical Center and Reading Hospital. "People shouldn't panic about that strain."
...
An investigation has not yet uncovered how the illness was transmitted.
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

If there is H2H transmission we ought to be seeing an increase in cases unless they are so mild that sick individuals are not being tested. It could be that swine H3N2 continues to circulate in the background among both pigs and humans making the inter species jump infrequently and not transmitting effectively after arriving in a human host. Perhaps cross protective immunity from earlier H3N2 strains is hampering widespread transmission.
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

The absurdly overlooked fact that 'swoH3N2 does cross react with seasonal human influenza H3N2 strain circulating in '90' implies that:

-- a sizeable proportion of population has cross reactive antibodies against this virus;

-- a vaccine seed should be readily available at repositories for emergency use if required;

-- the same proportion of population not naive to the virus since it had previous exposure to parent human influenza strain - could serve as asymptomatic carrier and thus drive spread into susceptible individuals (such as children born after 1998, for example);

-- overall, the swoH3N2 might have to compete with seasonal contemporary H3 and its transmissibility could not be enough to initiate an epidemic or conversely could displace the current H3 as seasonal component of winter epidemics.

We had a clear example of reintroduction of an ancient virus with H1N1 (2009) when a distant relative of contemporary H1N1 human strain reemerged but old people who experienced Spanish Flu virus infection or its immediate variants were less susceptible because the presence of antibodies that cross reacted with the surface glycoproteins similar if not identical to the ancient parent.

In the case of swoH3N2 the parent strain is much more recent (mid '90) and thus the proportion of people with some grade of immunity should be greater as well with respect H1N1 (2009).

The antigenic properties of surface glycoproteins of swoH3N2 cannot be obscured if the intent is to correctly evaluate the likelihood and the impact of a potential epidemic spread.
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

I am hoping that is the case. If there is little H2H transmission, then the swine to human transmission route must be particularly efficient as compared with typical swine strains.
If there is H2H transmission we ought to be seeing an increase in cases unless they are so mild that sick individuals are not being tested. It could be that swine H3N2 continues to circulate in the background among both pigs and humans making the inter species jump infrequently and not transmitting effectively after arriving in a human host. Perhaps cross protective immunity from earlier H3N2 strains is hampering widespread transmission.
 
Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

Re: Is H2H spread of a novel swine H3N2 occurring in the United States?

The new, Week 36, weekly CDC report now contains the statement that all three PA cases had "direct contact with swine", a somewhat stronger statement that previously made, and also gives the onset dates of August 18 and 21 (for the samples from August 25 and 26). It is possible that an infected pig was present somewhere around August 15 or 16, and they might yet find this virus in a pig.

Nevertheless, even if trH3N2 is not transmitting efficiently H2H right now, it remains dangerously close, and has to be something everyone keeps an eye on.
 
Back
Top Bottom