Rhiza Labs FluTracker Forum

Detail on 1st Pennsylvania case (2F)

Case 2 (Pennsylvania)
• A female child with a history of premature birth and mild asthma became ill with influenza-like
symptoms (fever, cough and fatigue) on August 20, 2011. The patient has since recovered
from her illness.
• The child had received influenza vaccine in September 2010, and was not treated with
influenza antiviral medications.
• The child was taken to a local hospital emergency department on August 20, 2011, where a
rapid influenza diagnostic test was positive for influenza A.
• Nasopharyngeal swab and nasal wash specimens were forwarded to the Pennsylvania
Department of Health Bureau of Laboratories as part of routine CDC-supported influenza
surveillance.
• On August 23, 2011, diagnostic testing of the specimens at the state laboratory indicated
suspect swine-origin influenza A (H3N2). Both specimens were forwarded to CDC for further
characterization.
• On August 26, 2011, the Influenza Division at CDC used genome sequencing to determine the
virus was swine-origin triple reassortant influenza A (H3N2) virus with the M gene from the
pandemic 2009 H1N1 virus.
• No epidemiologic links between this case and the Indiana case were identified.
• An investigation into the source of the exposure revealed direct contact between the patient
and swine. (The patient’s parent reported visiting an agricultural fair four days before the
onset of symptoms.)
• An International Health Regulation (IHR) report was submitted on August 26, 2011 per the
World Health Organizations reporting requirements in the event of a human infection with a
novel or animal origin influenza virus infection.

https://linksweb.oph.dhh.louisiana.gov/ ... 0IN_PA.pdf

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Detail on 2nd Pennsylvania case (9F)

Case 3 (Pennsylvania)
• A female child became ill with influenza-like symptoms (fever, abdominal pain, and vomiting)
on August 21, 2011. The patient did not see a clinician for her illness and continues to
recover.
• The child had received influenza vaccine during the 2010-2011 influenza season, and was not
treated with influenza antiviral medications.
• As part of an ongoing investigation into the initial case of swine-origin triple reassortant
influenza A (H3N2) virus infection in Pennsylvania, this child’s illness was identified and a
nasopharyngeal swab specimen was collected and forwarded to the Pennsylvania Department
of Health Bureau of Laboratories.
• Testing at the state laboratory was inconclusive and the specimen was sent to CDC for further
characterization.
• On September 2, 2011, the Influenza Division at CDC used partial genome sequencing to
indicate that the virus had NS, HA, and M gene segments consistent with the swine-origin
triple reassortant influenza A (H3N2) virus identified from the previous Pennsylvania and
Indiana cases.
• An investigation into the source of the exposure has revealed direct contact between the
patient and swine. (The patient exhibited market hogs at an agricultural fair from August 13 –
20, 2011.)
• Though direct exposure to swine has been confirmed, further investigation of the patient’s
contacts to determine any additional illness is ongoing.
• No direct contact between this case and the two other Pennsylvania cases has been identified.
• An International Health Regulation (IHR) report was submitted on September 6, 2011, per the
World Health Organizations reporting requirements in the event of a human infection with a
novel or animal origin influenza virus infection.

https://linksweb.oph.dhh.louisiana.gov/ ... 0IN_PA.pdf

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Detail on 3rd Pennsylvania case (9F)
Case 4 (Pennsylvania)
• A female child became ill with influenza symptoms (fever, shortness of breath, cough, nausea
and vomiting) on August 18 - 19, 2011.
• The child had received influenza vaccine during the 2010-2011 influenza season, and was not
treated with influenza antiviral medications.
• A respiratory specimen was obtained on August 25, 2011, as part of routine care, which was
identified as an un-subtypeable influenza A by the hospital laboratory. Nasopharyngeal swab
and nasal wash specimens were collected.
• On September 3, 2011, the specimen was forwarded to CDC for further characterization.
• On September 5, 2011, the Influenza Division at CDC used genome sequencing to determine
the virus was swine-origin triple reassortant influenza A (H3N2) virus with the M gene from
the pandemic 2009 H1N1 virus.
• The investigation has revealed multiple potential swine exposures. (The patient’s mother
reported the patient visited an agricultural fair for four days before the onset of symptoms.
The patient also visited a friend who participated as a swine exhibitor at the agricultural fair.)
• Further investigation of close contacts of the child, potential additional sources of the patient’s
infection and ill contacts of fair exhibitors and attendees is ongoing.
• No contact between this case and the previously reported Pennsylvania cases has been
identified.
• An International Health Regulation (IHR) report was submitted on September 6, 2011, per the
World Health Organizations reporting requirements in the event of a human infection with a
novel or animal origin influenza virus infection.

https://linksweb.oph.dhh.louisiana.gov/ ... 0IN_PA.pdf

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The trH3N2 cluster in Iowa ties Pennsylvania for the largest number of confirmed cases at a given site, but the Iowa cases are epidemiologically linked.

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Note case was unsubtypable.

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Note that testing was inconclusive.

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Note that the above patient visited the Washington County Fair 4 days prior to disease onset and visited Emergency Room 2 days after disease onset, suggesting presentation was in Schuylkill County in eastern PA.

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Thread on H3N2v cluster at LaPorte County Fair in Indiana
viewtopic.php?f=5&t=8163

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