SWINE FLUE raises its ugly head again in In­dia

The pan­demic stain is no longer re­ferred as “swine flu”, its cor­rect nomen­cla­ture is A(H1N1)pdm09 virus. Since 2009 this virus was anti­geni­cally sim­i­lar to A/Cal­i­for­nia/07/2009 which was rec­om­mended vac­cine com­po­nent from 2009 to 2016. This is the cur­rent

BioSpectrum (Asia) - - Front Page - Aish­warya Venkatesh aish­warya.venkatesh@mmac­tiv.com

At least 600 peo­ple have died and over 12,500 peo­ple have been af­fected by the deadly swine flu out­break in In­dia as of 28 July, 2017. The ris­ing cases have put the en­tire na­tion on red alert, with health of­fi­cials strug­gling to con­tain the virus that is mul­ti­ply­ing in­ces­santly in the In­dian soil. The panic but­ton has been hit, with the au­thor­i­ties and sci­en­tists scram­bling to con­trol the ris­ing num­ber of cases and deaths which is far more than in 2016.

As per the gov­ern­ment data, Ma­ha­rash­tra alone ac­counted for al­most 50 per cent of all deaths, this year, as it recorded nearly 300 deaths out of the 2,324 cases said a gov­ern­ment re­port. The coun­try has reg­is­tered 12,460 swine-flu cases so far this year as com­pared to 1,786 cases re­ported last year. So far, Gu­jarat recorded 75 deaths out of 289 in­fec­tions, while in Ker­ala 63 out of 1,127 peo­ple suc­cumbed to H1N1 com­pli­ca­tions. In Rajasthan, 59 per­sons died out of 407 re­ported cases. Karanataka had 15 deaths out of 2,377 cases, while Te­lan­gana and Tamil Nadu reg­is­tered 17 and 15 deaths out of 1,443 and 2,896 cases, re­spec­tively.

Along with the other states, the coun­try’s na­tional cap­i­tal Delhi is also strug­gling un­der the clutches of the virus. As many as 320 cases of the H1N1 virus have been re­ported from the na­tional cap­i­tal with two deaths. Health au­thor­i­ties have found that de­lays in di­ag­no­sis and treat­ment have been the ma­jor fac­tor lead­ing to deaths.

Though, sea­sonal in­fluenza may af­fect all age groups; glob­ally in­ci­dence is higher in young chil­dren and those above 65 years. How­ever, this year, ex­perts are alarmed at the steep rise in the num­ber of swine flu cases among young adults - about 40% of the deaths and 50% of the in­fec­tions are among peo­ple in the 2050 years age group, with no co-mor­bid con­di­tions.

A vi­ral ill­ness, Swine flu, causes se­ri­ous health prob­lems. The virus killed 981 peo­ple in 2009 and 1,763 in 2010. The mor­tal­ity de­creased in 2011 to 75. It claimed 405 lives in 2012 and 699 lives in 2013. In 2014, a to­tal of 218 peo­ple died from the H1N1 flu, In­dia recorded 837 lab­o­ra­tory con­firmed cases in the year. In 2016, the coun­try recorded 265 swine flu deaths, whereas in 2015 a to­tal of 42,592 cases and 2,990 deaths were re­ported. The World Health Or­ga­ni­za­tion called it a pan­demic in 2009 af­ter it started rapidly spread­ing glob­ally. In­dia was worst af­fected in by it in 2015 with 42,592 cases of which 3,000 were fa­tal.

Symp­toms in­clude – fever, cough sore throat, stuffy or runny nose, body aches, headache, chills, etc. Treat­ment is mainly symp­to­matic. The virus trans­mits from hu­mans to hu­mans through saliva and mu­cus par­ti­cles – sneez­ing, cough­ing, touch­ing a germ­cov­ered sur­face and then touch­ing their nose or eyes. Some of the pro­posed pre­ven­tive mea­sures for the dis­ease in­clude cov­er­ing the mouth while sneez­ing and avoid­ing di­rect or in­di­rect con­tact with peo­ple show­ing symp­toms of sea­sonal in­fluenza. A blood test for the H1N1 virus needs to be im­me­di­ately done if one suf­fers

from flu for more than three days.

Health work­ers and per­sons with co­mor­bid con­di­tions (such as lung dis­ease, heart dis­ease, liver dis­ease, kid­ney dis­ease, blood dis­or­ders, Di­a­betes) and im­muno-com­pro­mised per­sons are at higher risk. In­fluenza may have an ag­gres­sive course in ex­tremes of age and in co-mor­bid con­di­tions.

Sud­den rise in cases

H1N1 out­break had oc­curred in In­dia dur­ing the 2009 Swine flu pan­demic. Since then In­dia has seen steep rise in cases of swine flu ev­ery year. Surge in cases are seen gen­er­ally dur­ing win­ter when the tem­per­a­ture is con­ducive for the virus to thrive and mul­ti­ply. But this year, the on­set is much ear­lier. The death toll in Ma­ha­rash­tra so far this year is higher than the num­ber of deaths from H1N1 in the whole coun­try in 2016.

Speak­ing to BioSpec­trum Magazine, Dr DT Mourya, direc­tor, Na­tional In­sti­tute of Virol­ogy, said that the sud­den surge in the cases could be due to the mu­ta­tion in the virus. “The pan­demic stain is no longer re­ferred as “swine flu”, its cor­rect nomen­cla­ture is A(H1N1) pdm09 virus. Since 2009 A(H1N1)pdm09 virus was anti­geni­cally sim­i­lar to A/Cal­i­for­nia/07/2009 which was rec­om­mended vac­cine com­po­nent from 2009 to 2016. In 2016 virus evolved from A/Cal­i­for­nia/07/2009 to A/Michi­gan/45/2015 due to an ac­cu­mu­la­tion of point mu­ta­tions. This is the cur­rently glob­ally cir­cu­lat­ing virus as well as in In­dia and may be one of the rea­son for in­creased in­fluenza ac­tiv­ity. There­fore evolved virus has re­sulted in in­crease in sus­cep­ti­ble pop­u­la­tion, which may be rea­son for spurt of in­fluenza cases in In­dia.”

Gov­ern­ment steps up mea­sures

A cen­tral rapid re­sponse team was de­ployed in Ma­ha­rash­tra to in­ves­ti­gate the ris­ing trend of in­fluenza in the state and to pro­vide re­quired as­sis­tance which is re­sult­ing in re­duced mor­tal­ity cur­rently. To en­sure wider avail­abil­ity and ac­ces­si­bil­ity of Oseltamivir, the drug for treat­ment of in­fluenza, has been put in sched­ule H1 on June 22, which means they can be sold by all li­censed chemists against pre­scrip­tion. Ear­lier, they be­longed to Sched­ule X cat­e­gory, wherein only cer­tain se­lected phar­ma­cies were au­tho­rized to stock and sell the medicine.

“Twelve lab­o­ra­to­ries un­der In­te­grated Dis­ease Sur­veil­lance Pro­gram (IDSP) and 30 lab­o­ra­to­ries un­der the In­dian Coun­cil of Med­i­cal Re­search (ICMR) are pro­vid­ing di­ag­nos­tic ser­vices for de­tec­tion of the in­fluenza virus to states,” said, health Min­is­ter JP Nadda while speak­ing to a lead­ing daily. “The Min­istry of Health and Fam­ily Wel­fare has pro­cured lab­o­ra­tory di­ag­nos­tics (to test 20,000 sam­ples) for the labs in the IDSP and ICMR net­works.”

“How hard H1N1 strikes is in many cases a func­tion of aware­ness and pre­pared­ness. So, Delhi has re­ported 241 cases but only four deaths, while Gu­jarat has seen 289 cases and 75 deaths. It is also a func­tion of liv­ing con­di­tions — the more peo­ple are ex­posed to crowded places or un­hy­gienic liv­ing con­di­tions, more are they likely to con­tract the in­fec­tion,” he added.

An ad­vi­sory has also been is­sued by the state health depart­ment fol­low­ing a rise in the swine flu cases in other parts of the coun­try. The ad­vi­sory in­structs all hos­pi­tals to take im­me­di­ate ac­tion when a pa­tient is sus­pected of be­ing in­fected with swine flu.

To con­trol the vec­tor-borne dis­eases, the Delhi Gov­ern­ment an­nounced plans to launch an aware­ness cam­paign with the help of res­i­dent wel­fare as­so­ci­a­tion (RWA) to tackle the spread of vec­tor borne dis­eases. In Ma­ha­rash­tra, mem­bers of the In­dian Med­i­cal As­so­ci­a­tion (IMA) Mumbai dis­cussed the cause and pre­ven­tive mea­sures of swine flu with the health min­is­ter. It was also de­cided that the IMA would go ahead with a joint ven­ture with gov­ern­ment of Ma­ha­rash­tra and BMC to tackle the threat posed by these dis­ease.

Dr Mourya said, “ICMR has de­vel­oped vi­ral di­ag­nos­tic Lab­o­ra­tory network (28 labs) to cater

for timely di­ag­no­sis of A(H1N1)pdm09. Sup­ply of reagents, train­ing and equip­ment are pro­vided by ICMR. This aims at early de­tec­tion of dis­ease for clin­i­cal man­age­ment and pub­lic health mea­surer so as to ar­rest spread of dis­ease.”

Prevention

The best way to pre­vent swine flu is to get a yearly flu vac­ci­na­tion, although no vac­cine pro­vides 100% pro­tec­tion. In its guide­lines, the Min­istry of Health and Fam­ily Wel­fare, men­tioned, “In­fluenza vac­ci­na­tion is most ef­fec­tive when cir­cu­lat­ing viruses are well­matched with vac­cine viruses. Even with ap­pro­pri­ate match­ing, ef­fi­cacy of vac­cine may be about 70% to 80%. In case the lo­cally cir­cu­lat­ing virus is dif­fer­ent from vac­cine virus rec­om­mended by WHO, it may be par­tially ef­fec­tive or not be ef­fec­tive at all. Hence, vac­cine should not give a false sense of se­cu­rity. Con­sid­er­ing the risk per­spec­tive, the modal­i­ties of in­fec­tion prevention and con­trol prac­tices like per­sonal hy­giene, fre­quent wash­ing of hands, res­pi­ra­tory eti­quettes and air­borne pre­cau­tions (in hospi­tal set­tings or domi­cil­iary care set­tings) should be strictly ad­hered to.”

Be­cause swine flu is very con­ta­gious, peo­ple at high risk groups are rec­om­mended to take a shot, es­pe­cially, if suf­fer­ing from ill­nesses such as asthma, heart dis­ease, di­a­betes, hy­per­ten­sion, on im­muno­sup­pres­sants, can­cer treat­ment, etc. Health-care fa­cil­i­ties (HCF) face the chal­lenge of pro­vid­ing care for pa­tients in­fected with the virus. It is critical that health-care work­ers (HCW), pa­tients, and vis­i­tors fol­low the ap­pro­pri­ate in­fec­tion con­trol (IC) pre­cau­tions in or­der to min­i­mize the pos­si­bil­ity of trans­mis­sion associated with health care.

“In ad­di­tion to univer­sal pre­cau­tion­ary prac­tices, we rec­om­mend vac­ci­na­tion for high-risk in­di­vid­u­als such as health care work­ers, preg­nant women, peo­ple with co mor­bid con­di­tions (di­a­betes, hy­per­ten­sion, obe­sity etc.). The Ma­ha­rash­tra Pub­lic health depart­ment has adopted these rec­om­men­da­tions. Vac­cine con­tain­ing the cur­rently cir­cu­lat­ing A/Michi­gan/45/2015 is com­mer­cially avail­able,” con­cluded Dr Mourya.

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