Recombinomics Commentary

The fatalities are a 35-year-old woman from Garden Hill, and a man around 35 years old who got sick at Garden Hill but was a resident of Red Sucker Lake. The third woman is fighting for her life in hospital in Winnipeg. And Grand Chief David Harper of Manitoba Keewatinowi Okimakanak said more than 20 other residents of the northern community are “coughing up blood.”

The above comments describe an H3N2 outbreak in northern Manitoba.  Although the outbreak is being described as seasonal H3N2, the severity of the disease in previously healthy young adults raises concerns that the H3N2 detected is trH3N2. trH3N2 has a seasonal H3 and N2 from the 1990’s but is a triple reassortant with an avian PB2 and PA, and a human PB1 from 1996. The remaining gene segments are swine.  WHO recently issued a pager alert on two trH3N2 cases in the United States.  

The sequences were recently released at GISAID by the CDC and the isolate from Wisconsin (A/Wisconsin/12/2010) and Pennsylvania (A/Pennsylvania/14/2010) are very closely related to each other, raising human transmission concerns since the two patients did not have contact with each other and were infected 6 weeks apart (Snip).

It is unusual for H3N2 to produce fatalities in previously healthy young adults. (Snip) In addition to the outbreak in Manitoba, media reports describe an H3N2 outbreak in Mongolia that is also H3N2 and affecting children. The media reports reference the trH3N2 cases in the US, but it is not clear if the Mongolia cases are seasonal H3N2 or trH3N2.

trH3N2 in Canada or Mongolia would signal a swine H3N2 pandemic.  More information on these cases as well as the fatal H3N2 outbreak in Akita, Japan would be useful.

•  Azerbaijan confirms bird flu outbreak (in birds) in its west (Link)

•  Northern Manitoba chief calls for help with killer flu (Link)

•  Hong Kong lowers bird flu alert after first case in seven years (Link)

•  Two Egyptian women die from swine flu, bird flu (Link)

•  WHO confirms fatal H5N1 case (Link)
•  Authorities detect 89 bird flu spots in Nile Delta (Link)

•  Shimane incinerates all 21,500 chickens at bird flu-affected farm (Link)

•  Bird-flu steps complete – Shimane (Link)

•  H5N1 outbreak in poultry (Link)

New Zealand
•  Massey to teach Asian public health specialists (Link)

•  DENR intensifies measures against bird flu (Link)

South Korea
•  H5N1 in birds (Link)
•  Single avian flu case in N. Jeolla (Link)

United States
•  CDC: Flu already hitting Georgia hard (Link)

•  Illnesses may signal early start of flu season (Link)
•  FL: Influenza Cases are now Being Reported in Palm Beach County by MD Now Urgent Care Centers (Link)

•  IA: 3 flu strains identified in Iowa (Link)
•  WA: Public Health in search of volunteers to spread medical care in disasters, medical crises (Link)
•  WY: Wyoming Health Dept. Encourages Flu Vaccinations (Link)

•  CDC says to expect three strains of flu (Link)
•  Wild birds carry avian flu viruses to North America: Report (Link)

•  North told to focus on bird flu prevention  (Link)

•  Three H5N1 outbreaks in poultry (Link)

•  H5N1 flu is back (Link)

•  Contract from BARDA to Develop Next Generation Adjuvants for Pandemic Influenza  (Link)
•  BARDA funds medical countermeasure innovation (Link)

•  Over-Reactive Immune System Kills Young Adults During Pandemic Flu (Link)

•  Study: Vaccination sequence affected response to 2009 H1N1 vaccine (Link)
•  Why H1N1 could be fatal to young adults (Link)

•  Drug Resistance, Person-to-Person Transmission Increasing Among Flu Strains (see note below on link) (Link)

•  Eyewitness accounts of the 1510 influenza pandemic in Europe (Link)

•  H5N1–Where Is It? (Link)

•  Recombinomics: Spike In Garden Hill Cases Raises trH3N2 Concerns (Link)