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More recently, investigation of a case in West Virginia has identified a possible outbreak, with 23 out of 70 contacts of the case reporting ILI; all have recovered.

http://peds.stanford.edu/chiefsblog/201 ... 20H3N2.pdf

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The above comment in the California Department of Public Health Alert was NOT in the early release MMWR.

http://www.cdc.gov/mmwr/preview/mmwrhtm ... 0e1223a1_w

The above numbers indicate the attack rate was high in the West Virginia cluster, where only two cases were confired, and the second case was originally listed as influenza A (see graph at link below)

http://www.recombinomics.com/News/12161 ... V_H2H.html

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Sustained trH3N2 Transmission In West Virginia
Recombinomics Commentary 12:30
December 25, 2011

On November 19, a child aged <5 years developed acute onset of fever after 1 week of cough and congestion. The child had been hospitalized for an unrelated condition 2 days before the onset of fever. On November 21, a respiratory specimen was collected. Rapid diagnostic tests conducted by the hospital were negative for influenza and respiratory syncytial virus, but influenza A was identified by an alternative rRT-PCR at the hospital. The specimen was forwarded to the West Virginia Office of Laboratory Services, where it was identified as a suspected influenza A (H3N2)v virus. Subsequent genome sequencing conducted at CDC confirmed the virus as A(H3N2)v with the M gene from the A(H1N1)pdm09 virus.

An investigation was conducted to ascertain respiratory illnesses among contacts of the child that occurred during November 9–December 19. Multiple contacts, including children who regularly attended day care with the child, were found to have had respiratory illness during this period. On November 29, a second child aged <5 years who attended day care regularly with the first child and who had no recent travel or swine exposure became ill with fever, cough, diarrhea, and rhinorrhea. The second child did not seek medical care and recovered fully from the illness. A respiratory specimen obtained from the second child on December 7 was inconclusive by rRT-PCR at the West Virginia Office of Laboratory Services; however, the specimen was confirmed as influenza A (H3N2)v with the M gene from the A(H1N1)pdm09 virus via genome sequencing at CDC.

http://www.recombinomics.com/News/12251 ... ained.html

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Although there were almost certainly more than two dozen trH3N2 cases linked to this daycare center, the index case (A/West Virginia/06/2011) initially tested negative, and the confirmed contact (A/West Virginia/07/2011) was inconclusive and originaly listed as infleunza A positive.

Similar outbreaks are almost certainly going unreported because cases are mild and testing is unreliable in samples with low RNA levels.

Anectdotal reports indicate ILI is widespread in Northern Califonia, where a Napa County pediatric case has tested positive for trH3N2.

Appropriate testing will lead to an explosion of cases and clusters.

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Commentary

http://www.recombinomics.com/News/01051 ... LI_23.html

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Commentary

http://www.recombinomics.com/News/01051 ... WV_MP.html

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Commentary

http://www.recombinomics.com/News/01051 ... ation.html

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Today the CDC published the December 23 early release MMWR, which described the West Virginia cluster, which made it clear that transmission was sustained for a month at the daycare center, but failed to note that 23 contacts had ILI.

http://www.court.us/idar4903938/us_hhs_ ... online.htm

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C45A
EPI346924 A/West Virginia/07/2011 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI346919 A/Wisconsin/28/2011 (A/H1N1) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI346488 A/West Virginia/06/2011 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI346435 A/Iowa/08/2011 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI346427 A/Iowa/07/2011 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI346419 A/Iowa/09/2011 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI344392 A/Indiana/10/2011 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI344385 A/Indiana/10/2011 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI342699 A/Iowa/09/2011 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI342691 A/Iowa/08/2011 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI342683 A/Iowa/07/2011 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI342600 A/swine/NY/A01104005/2011 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI341736 A/swine/Iowa/A01049970/2011 (A/H1N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI341732 A/swine/Iowa/A01202033/2011 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI341731 A/swine/Iowa/A01202034/2011 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI340979 A/Indiana/10/2011 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI339166 A/Maine/06/2011 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI338531 A/swine/Iowa/A01049755/2011 (A/H1N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI338530 A/swine/Iowa/A01049765/2011 (A/H1N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI338529 A/swine/Iowa/A01049766/2011 (A/H1N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI335681 A/swine/Italy/18/2000 (A/H1N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI335678 A/swine/Italy/81226/2009 (A/H1N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI335677 A/swine/Italy/70757/2009 (A/H1N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI335676 A/swine/Italy/320546/2009 (A/H1N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI325614 A/swine/MN/25618/2011 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI324229 A/swine/MB/36/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI324223 A/swine/MB/22/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI324219 A/swine/MB/54/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI324207 A/swine/MB/32-2/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI324199 A/swine/MB/31/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI324183 A/swine/MB/10422/2009 (A/H1N1) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI324175 A/swine/MB/46/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI316953 A/swine/Iowa/A01049004/2010 (A/H1N1) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI316952 A/swine/Iowa/A01049003/2010 (A/H1N1) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI306432 A/swine/Sweden/9706/2010 (A/H1N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI303270 A/Canada-MB/RV2013-10/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI301711 A/Hawaii/16/2010 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI281120 A/swine/Italy/58769/2010 (A/H1N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI271150 A/Aarhus/INS254/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI257701 A/Neimenggu-Huimin/SWL11560/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI252557 A/Ontario/9739/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI252549 A/Ontario/9698/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI214926 A/swine/Sweden/1021/2009 (A/H1N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI214088 A/Toronto/T9842/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI214080 A/Toronto/T5362/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI213998 A/Thailand/CU-H340/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI213980 A/Thailand/CU-B938/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI190923 A/Canada-SK/RV2486/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI186737 A/Canada-MB/RV2020/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI186735 A/Canada-MB/RV2013/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI186734 A/Canada-MB/RV1982/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI186733 A/Canada-MB/RV1977/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI186731 A/Canada-MB/RV1964/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI186718 A/Canada-MB/RV2023/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI180276 A/Shandong/1/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI179594 A/Shandong/1/2009 (A/H1N1 pdm09) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI174541 A/swine/Muesleringen-S./IDT4263/05 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)
EPI174536 A/swine/Hertzen/IDT4317/05 (A/H3N2) segment 7 (MP) 27.0 7.416323e+00 14/14 (100%)

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New Swine Flu Concerns in West Virginia
New strain found in West Virginia, 4 other statesBy Andy Salsman | Thursday, Jan 12, 2012 | Updated 1:25 PM EST

There is new concern about a new strain of Swine Flu, which has sickened at least 12 Americans.

The new strand, called H3N2v, is a mutated version of the original H1N1 Swine Flu virus. The CDC is now investigating whether the virus can be transmitted from human to human.

“While there is no evidence that sustained human-to-human transmission is occurring, all influenza viruses have the capacity to change and it’s possible that this virus may become widespread,” the CDC wrote on its website.

Patients with the new Swine Flu live in West Virginia, Pennsylvania, Iowa, Maine, and Indiana.

Health officials are hoping this strand is not as serious as H1N1, which killed more than 17,000 people around the world between 2009 and mid-2010.

http://www.nbcwashington.com/news/healt ... 70918.html

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