WHO Silence On Swine H3N2 Case In Illinois Raises Concerns
Recombinomics Commentary 18:54
November 11, 2010

The WHO put out a pager alert on two patients in the United States who had been infected with swine H3N2, which is rare.  The last reported case in the US was a relatively mild case in Iowa reported in early 2010.  A swine link for the case was not found, but neither was sustained transmission.

However, in yesterday’s pager alert, which was widely carried by media in eastern Europe (Russia, Ukraine, Georgia, Azerbiajan), two new cases were identified.  The case (46M) from Pennsylvania is listed in tomorrow’s MMWR from the CDC, while the second case (7 month-old) from Illinois is not mentioned.  The details on this case are critical, because if this case is in the same time frame as the PA case and the sequence and constellation of H3N2 triple reassortant is similar, these two cases likely represent the tip of a very large iceberg and signal an H3N2 swine pandemic.

The silence by the CDC on the Illinois case, as well as the genetic similarity between the two cases, raises additional pandemic concerns.  Similarly, the failure of the WHO to release a written report on these two cases also raises pandemic concerns.

Sustained transmission of swine H3N2 has never been reported previously.  There have been occasional reports, such as the Iowa case which had a disease onset date in September, 2009.  Consequently, two new cases announced at the same time which are more than 500 miles apart bear a striking similarity to the first two reported pH1N1 cases in southern California.  Additional cases were quickly identified in the US, and when it was clear that the pH1N1 in the US was similar to the pH1N1 in Mexico, there was little doubt that the 2009 pandemic had begun.

Confirmation of matching swine H3N2 in the PA and IL cases, coupled with a lack of contacts would suggest that new H3N2 swine flu cases would also be quickly found and signal another pandemic.

Thus, additional information on disease onset dates, as well as sequence data of the US cases, as well as the fatal H3N2 cases in Akita, Japan would be useful.

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