Swine flu impact highest in four states As cases rise in Delhi, primary health centres struggle to cope

VIRUS ALERT 2,101 cases between Jan 28 and Feb 3; 61% of the cases across India reported from Rajasthan, Delhi, Punjab, Haryana

NEWDELHI: North India has been worst hit by influenza (A) H1N1 or swine flu this year, with at least 61% cases reported from across the country coming from Rajasthan, Delhi, Haryana and Punjab.

According to surveillance data collected under the government’s Integrated Diseases Surveillance Programme (IDSP), the week between January 28 and February 3 this year was particularly bad as 1,176 of the 2,101 cases that tested positive during this period were from the four north Indian states.

Again, of a total of 6,701 cases, as many as 4,114 were reported from these states with Rajasthan reporting 2,363 cases, Delhi 1,011, Haryana 490 and Punjab 250 cases.

Of 226 swine flu deaths, 117 were reported from three of these states, except Delhi that has officially reported no death.

Experts have, however, warned against creating panic, saying this was a cyclic phenomenon.

“Flu cases are either due to influenza (A) H1N1, H3N2 or influenza B. There will always be a strain or a combination of strains that is more prevalent than the other and cause infection.

There is an increase in the number of cases when the unimmunised population pool increases. This can be due to migration and new births. DR NIVEDITA GUPTA, scientist

There’s largely immunity within the community against the strains but whenever there is a build-up of people who aren’t exposed to the prevalent strain, infections will go up,” said an expert in a government laboratory requesting anonymity as the expert is not authorized to speak to the media.

There are typically two peak flu seasons -- monsoon (Augustoctober) and winter (Januarymarch).

While H3N2 was the dominant strain last monsoon, between 70-90% of the cases this winter were found carrying the H1N1 strain.

“There is an increase in the number of cases reported when the pool of unimmunised population increases. This can be due to migration and new births. But it can also be because of the changing structure of the virus that leaves the population without immunity,” said Dr Nivedita Gupta, senior scientist at Indian Council of Medical Research (ICMR).

The H1N1 outbreak in 2009 had sparked fears that it would be the killer virus of the future. But the fear has proved unfounded, said an expert not wishing to be named.

“The cases and deaths aren’t higher than what we have seen in other parts of the world. All flu cases have the potential of causing death in about 1% of those infected. There has been no higher pattern seen.

“Also, deaths mostly happen in cases that have some underlying medical condition or in those with low immunity,” said the expert.

Dr Nivedita Gupta, senior scientist at ICMR, said, “The flu virus is very dynamic and its antigenic structure keeps changing, so it is impossible to predict when the next spurt would be. This is also the reason we do not have any universal vaccine for flu.”

Another trigger could be the climate as a drop in temperature provides the virus a conducive environment to grow.

“Climate makes some difference and may add to the numbers. Since this year the winter was colder, the numbers started pouring in early and may ebb sooner,” he said. NEW DELHI: Although Delhi has reported the second-highest number of influenza (A) H1N1 or swine flu cases this year after Rajasthan, primary healthcare centres in the national capital appear ill-equipped to handle the rush of patients.

According to a report by the Integrated Disease Surveillance Programme (IDSP), Delhi has recorded 1,011 cases till February 3 this year. The government has not officially recorded any deaths, but three hospitals in the city have informally confirmed 19 deaths. Rajasthan reported 2,363 swine flu cases and 85 deaths.

“We don’t know why there has been a spurt in cases this year; the prolonged winter can be a reason. We have asked researchers at AIIMS (All India Institute of Medical Sciences) whether there is any change in the virus structure. However, we are prepared. We have enough medicine — over 1 lakh tablets — masks and personal protective equipment for our staff,” said Dr SM Raheja, additional director and head of Delhi’s IDSP cell.

Although the government has been claiming that it has a “sufficient stock of medicines”, these don’t appear to be reaching dispensaries and mohalla clinics which are continuing to provide symptomatic treatment.

“We do get several patients with flu-like symptoms. We just give them symptomatic treatment — medicines for the fever and runny nose and ask them to take rest. The testing facility and medicines are available only in hospitals,” said a doctor on duty at a dispensary in Chattarpur on condition of anonymity.

The Delhi government runs 260 dispensaries and polyclinics and 180 mohalla clinics in the city. Six of the seven primary healthcare centres contacted by Hindustan Times said the medicine to treat swine flu – Tamiflu -had not reached them.

“The dispensaries can ask the chief district medical officer for medicines. We have already written to them about it,” said Dr Raheja.