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Commentary
ProMED Comment
On trH3N2 Rumor Raises Concerns
Recombinomics Commentary 13:20
November 4, 2011
This is genetically similar to 4 previous cases identified in the United States this year [2011], 3 in Pennsylvania and one in Indiana, all of which had exposure to swine.
[This press report has been incorrectly interpreted elsewhere as confirmation of transmission of a swine-origin reassortant A/H3N2 influenza virus to humans from pigs in New Hampshire. Transmission of this strain of influenza virus occurred in isolated cases in the states of Indiana, Maine, and Pennsylvania, with no onward human-to-human transmission. These cases are described in detail in the ProMED-mail references below.
No transmission (or isolation) of this swine-origin reassortant H3N2 influenza virus has occurred in the state of New Hampshire as far as is known at present.
The HealthMap/ProMED-mail interactive map of the state of Maine can be accessed at http://healthmap.org/r/1m1U. - Mod.CP]
The above statements and the bracketed comments are from a ProMED report on an unsourced rumor / misunderstanding regarding the origin of the trH3N2 identified in the first reported case in Maine, 8M – A/Maine/06/2011, who developed symptoms on October 7, 2011. This rumor appears to be private, since internet searches of New Hampshire and the case in Maine only return the ProMED report or comments associated with the ProMED report. The press report does not claim that New Hampshire swine are the source of infection in the Maine case, but does issue a warning for swine farmers in New Hampshire due to the Maine case, who had a swine exposure at an agricultural fair, presumably the Cumberland County fair (in Cumberland, about 30 miles from the New Hampshire border) which ended on October 2, in the week prior to symptoms in the Cumberland County case.
The press report cited above had three glaring errors. The first was minor when the origin article stated that the 16 HA serotypes and 9 NA serotypes could produce 1,454 combinations when in fact the number of combinations was simply the product of the two serotypes, 144 (16X9=144). The edited version in the ProMED report removed the comma, but reported 1454 instead of 144, suggesting the editor was more focus on form than substance.
However, the other glaring errors where of significant substance, claiming that none of the 26 human triple reassortants in the United States were due to human to human transmission, when the CDC had already acknowledged human to human transmission, including the most recent lab confirmed trH3N2 case in 2010 (daughter of the Minnesota index case), as well as the first trH3N2 case (the child, 2M, from Indiana who had no swine exposure).
The case also voided the second error of substance which maintained that all 2011 trH3N2 cases had swine exposure, which was stated in the Maine CDC report on the first Maine case, which precipitated the above press report from New Hampshire, which also stated that all prior 2011 trH3N2 had swine exposure.
ProMED had carried an earlier report on the first Maine case, which also cited a swine exposure for all four prior 2011 trH3N2 cases, and a Recombinomics commentary cited the error and suggested ProMED correct this error, which was not done in the earlier comments.
However, instead of correcting the error, ProMED issued a second report which not only repeated the swine exposure error and added the comment on no human to human transmission, which was also stated in the above comment claim no onward human transmission, which were acknowledged by the CDC, who had modified its earlier statements on no human transmission for trH3N2 cases to no sustained human transmission.
Thus, although the CDC has acknowledge human to human transmission for trH3N2, including the latest trH3N2 constellation, which has the H1N1pandemic 09 M gene, the underplaying of the data which supports this transmission, as well as the significance of fining the same constellation in all five human cases discussed above, as well as the two additional cases released this week, has led to this widespread misconception that trH3N2 has not transmitted to human to human, and is always linked to swine exposure.
Thus, ProMed should issue a new report clarifying these points which were published without clarification its two most recent reports on the first trH3n2 case in Maine (and ProMED has also been notified of the two additional cases confirmed this week which increases the number of human cases to with this novel constellation to seven (two in Indiana and Maine and three in Pennsylvania), while the constellation has yet to be reported in swine in Indiana, Maine, Pennsylvania, or anywhere in the world.
The repeated reporting of swine exposure for all 2011 trH3N2, which is clearly voided by the first case from Indiana, continues to cause concern.
In today's week 43 FluView, the CDC will likely comment on the latest cases from Maine and Indiana. Therefore, a review of prior comments on trH3N2 cases, including swine exposure and human transmission is due and associated agency mis-statements and media myths is due.
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