Rhiza Labs FluTracker Forum

Who tests the samples? Only state labs and the CDC can detect trH3N2 and trH1N2 (which requires the new CDC PCR test and confirmation with sequencing).

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www.twitter.com/hniman

I'm not implying that anybody is testing for trH3N2. (Honestly, I highly doubt that any doctors would even know what it was.) Only that there seems to be an increase in the number of flu tests in general. That's all.

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"Old Mother Goose, when she wanted to wander, would ride through the air on a very fine gander."
1916
"Mother Goose had a house,
'Twas built in a wood,
Where an owl at the door
For sentinel stood."

I was just trying to get a feel for how aggressive the CDC was. There actually are THREE novel viruses in humans at this time other than H1N1pdm09 (H3N2pdm11, trH3N2, trH1N2), and detection requires a more sophisticated PCR test that is usually done by the state labs (and then sent to the CDC).

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www.twitter.com/hniman

~ I worked the pediatric floor today, and I have to tell you that there is a dominating virus out there (That is NOT RSV) that seems to be causing a viral pneumonia clinical picture in babies and toddlers. They sound JUST like RSV kids, and are just as sick, but they test negative for RSV. One two year old came in today in severe distress from a doctor's office. I was alarmed at the work of breathing the child exhibited. He wasn't wheezing (even though he had a history of reactive airway syndrome). He had bilateral infiltrates by x-ray... and looked like he had viral pneumonia. The onset was sudden. Within 24 hours... He went from home, to the doctor's office to the hospital, and to the Unit (PICU) within one day. However he had NO fever. So they did not test for flu. Has this trH3N2 been associated with fever? Does it have an avian PB2 gene like H1N1 has? How does this new triple reassortant virus present?

_________________
"Old Mother Goose, when she wanted to wander, would ride through the air on a very fine gander."
1916
"Mother Goose had a house,
'Twas built in a wood,
Where an owl at the door
For sentinel stood."

~ it would be helpful to know the symptoms... (and if they differ from seasonal flu) I know there have only been a few "documented" cases, but that info. would be valuable.

_________________
"Old Mother Goose, when she wanted to wander, would ride through the air on a very fine gander."
1916
"Mother Goose had a house,
'Twas built in a wood,
Where an owl at the door
For sentinel stood."

~ Since I was up on the Pediatric floor, I asked two of the pediatricians (that I saw) if they had seen much flu lately. both of them said no. That they don't think the season has begun yet. They said they are testing for it, but they've had very few positives. However, the positives they did have seemed to be in late August, and not recently. That's kind of wierd.

_________________
"Old Mother Goose, when she wanted to wander, would ride through the air on a very fine gander."
1916
"Mother Goose had a house,
'Twas built in a wood,
Where an owl at the door
For sentinel stood."

Yes, the internal genes are the same as H1N1pdm09 (avian PA and PB2). The presentations for the first Indiana case (2M) and Pennsylvania case (2F) were given in the Sept 2 MMWR. Half of H1N1pdm09 had no fever, so this could be any of the novel influenza (all should give an influenza A positive, especially if tested by PCR).

Sounds like flu to me.

_________________
www.twitter.com/hniman

Patient A. On August 17, 2011, CDC was notified by the Indiana State Department of Health Laboratories of a suspected case of swine-origin influenza A (H3N2) infection in a boy aged <5 years. The boy, who had received influenza vaccine in September 2010, experienced onset of fever, cough, shortness of breath, diarrhea, and sore throat on July 23, 2011. He was brought to a local emergency department (ED) where a respiratory specimen later tested positive for influenza A (H3). The boy was discharged home, but was not treated with influenza antiviral medications. He has multiple chronic health conditions, returned to the ED on July 24, 2011, and was hospitalized for treatment of those health problems, which had worsened. The boy was discharged home on July 27, 2011, and has since recovered from this illness. As part of routine CDC-supported influenza surveillance, the respiratory specimen collected on July 24, 2011, was forwarded to the Indiana State Department of Health Laboratories, where polymerase chain reaction (PCR) testing identified a suspect swine-origin influenza A (H3N2) virus on August 17, 2011. The specimen was forwarded to CDC where the findings were confirmed through genome sequencing on August 19, 2011.

No direct exposure to swine was identified for this child; however, a caretaker reported direct contact with asymptomatic swine in the weeks before the boy's illness onset and provided care to the child 2 days before illness onset. No respiratory illness was identified in any of the child's family or close contacts, the boy's caretaker, or in the family or contacts of the caretaker.

Patient B. On August 24, 2011, CDC was notified by the Pennsylvania Department of Health of a suspected case of swine-origin influenza A (H3N2) virus infection in a girl aged <5 years. The girl, who had received influenza vaccine in September 2010, experienced acute onset of fever, nonproductive cough, and lethargy on August 20, 2011. She was brought to a local hospital ED where a nasopharyngeal swab tested positive for influenza A by rapid influenza diagnostic test. She was not treated with influenza antiviral medications and was discharged home the same day. The girl has completely recovered from this illness.

A nasopharyngeal swab and nasal wash specimen were obtained at the ED and forwarded to the Pennsylvania State Department of Health Bureau of Laboratories for additional testing as part of routine CDC-supported influenza surveillance. On August 23, 2011, the state public health laboratory identified a suspected swine-origin influenza A (H3N2) virus by PCR testing, and both specimens were forwarded to CDC. On August 26, 2011, genome sequencing confirmed the virus as swine-origin influenza A (H3N2). On August 16, 2011, the girl was reported to have visited an agricultural fair where she had direct exposure to swine and other animals. No additional illness in the girl's family or close contacts has been identified, but illness in other fair attendees continues to be investigated. No additional confirmed swine-origin influenza virus infections have been identified thus far.

_________________
www.twitter.com/hniman

~ well, it Looked like flu to me (especially the really sick toddler). I couldn't think of anything that would cause the symptoms he had. I was honestly alarmed because his X-ray reminded me of some of those 2009 victims 24 hours before they ended up on a ventilator.

However... we're back to square one. When there is no fever, there's no flu testing. Period. (not where I work) and it's a teaching hospital, so that logic trickles down the stairwell...

_________________
"Old Mother Goose, when she wanted to wander, would ride through the air on a very fine gander."
1916
"Mother Goose had a house,
'Twas built in a wood,
Where an owl at the door
For sentinel stood."

~ Thanks for those case studies. They all three presented with fever, and maybe that's why they were initially diagonsed. (Seems like the kids had to get worse before any subtyping was done) That was also the rule in 2009. My co-worker has an elementary aged child who also tested positive for flu A this past August (of course no subtyping was done) but we all know how regular seasonal flu loves to rear it's head in August around here. They have a pet pot belly pig who lives in the house. So I guess that counts as an exposure to swine.

_________________
"Old Mother Goose, when she wanted to wander, would ride through the air on a very fine gander."
1916
"Mother Goose had a house,
'Twas built in a wood,
Where an owl at the door
For sentinel stood."