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Severe Young Adult Garden Hill Cases Raise trH3N2 Concerns
Recombinomics Commentary 20:15
December 5, 2010

Joel Kettner said he’s “always concerned” about influenza and the potential effects the virus can have on Manitobans, but cautioned people not to jump to conclusions about what the deaths of two Garden Hill First Nation residents who caught the flu mean for the rest of the province.

“We don’t have any evidence at this time that we’re dealing with a pandemic or a new virus, or a virus that’s more serious than in previous years,” he said.

The above comments on the Garden Hills fatalities have been widely cited in media reports as evidence that the outbreak was due to seasonal H3N2, which was widespread in Canada and throughout the world.  However, the week 47 report out of Manitoba shows a dramatic jump in cases in the Burntwood Region, including 2 hospitalizations, 2 ICU cases, and one death.  Although the new cases were influenza A, and nine had been characterized as H3N2, none had been antigenically characterized.  The only antigenically characterized isolate from Manitoba was an isolate collected in week 39 from the Norman Region.

The week 46 report had 6 lab confirmed cases to date, with 5 of the 6 from Winnipeg.  None of the six had been hospitalized.  The week 47 report had 31 new cases, with 25 from Burntwood Region, location of Garden Hill. Nine of these cases were serotyped as H3N2, while the remained were influenza A, unsubtyped.  All cases were younger than 60.  The highest age group frequency was 30-39, which had 7 new cases, followed by 6 under 1, and 6 1-4 years of age.

The week 47 report covers cases through November 27, so the second fatality and the critical case medevacked from Garden Hill may not have been included. 

The week 47 report demonstrates a sharp increase in severe or fatal cases, all of which were under 65, raising concerns that the H3N2 cases were trH3N2 instead of Perth/16-like seasonal H3N2.  The week 47 report provides no data to support antigenic characterization of the cases from Garden Hills and raises concerns that the assumption that the H3N2 serotype signals Perth-16-like H3N2 may be in error.

Release of antigenic characterization and sequence data from the recent Garden Hill cases is of critical importance.

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