CDC Silence On Swine H3N2 Case In Illinois Raises Concerns
Recombinomics Commentary 14:30
November 11, 2010

There have now been hundreds of reports in newspapers in Russia, Ukraine, Georgia, and Azerbaijan on the WHO pager notification on two swine H3N2 cases in the United States.  One (42M in Pennsylvania) is noted in tomorrow’s CDC MMWR on week 44.  The other (7 month old in Illinois) has not been described by the CDC.  Tomorrow’s MMWR increase the number of US cases of novel H3N2 cases to two, but the earlier case was first noted in the June 18, MMWR week 23), but was not listed as current in that report.  Moreover, no June case was described by the CDC or media reports and the footnote merely states that the case was reported in 2010.  The earlier case is likely in reference to an adult case in Iowa, which was reported by the CDC in their week 1 report for 2010.  The case was not hospitalized and was symptomatic in September 2009, but was not investigated until November, 2009 and not reported until January 2010.

The lack of CDC comment on the 7 month old is a concern, as is the absence of a written report by WHO.  The mention of both cases in the pager alert suggests that both cases have closely related sequences, which point toward sustained transmission and the emergence of an H3N2 swine pandemic involving triple reassortants. 

It is unclear if the six gene segments other than H and N match pH1N1 or other swine triple reassortants.  It is also unclear if the human H3 and N2 are the 1990’s version in North American swine (which is widespread in swine), or represent more contemporary seasonal H3N2 sequences.

Details on the two cases, including dates of symptoms, contacts, and sequence data would be useful. 

The CDC silence on the Illinois case increases pandemic concerns.

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