HINI

“What we need is infection control measures used to contain any other infections, such as tuberculosis,” said Dr Guleria, who is a professor of pulmonology at AIIMS and a member of the World Health Organization’s (WHO) Scientific Advisory Group of Experts on influenza vaccination for emerging markets.

“Instead of focusing on testing and treating one seasonal viral strain, India now needs to focus on classifying the severity of illness, as the treatment for severe illness from all four viruses infections remains the same – vaccinating people within 48 hours of infection, using anti-virals and giving ICU and ECMO support, when needed,” Dr Guleria added.

ECMO, or extracorporeal membrane oxygenation, provides heart-lung bypass support by pumping oxygenated blood into the body to people undergoing bypass surgery or for those in acute respiratory distress.

According to WHO, 98.3% flu infections are caused by influenza A, of which H1N1 accounts for 77.7% infections, and H3N2 for 22.3%. In India, people with flu are tested only for H1N1, with H3N2 testing done for only research purposes.

“H1N1 is no more deadly than the other three influenza viruses — H3N2, B Victoria lineage, and B Yamagata lineage — causing seasonal flu in 2019; it’s just more feared because it’s the only flu virus people hospitalised with flu-related complications are tested for,” said Dr Anil K Prasad, former professor of virology at Patel Chest Institute and chairman of the Influenza Foundation of India.

With dominant strains changing almost every year, WHO tracks global flu outbreaks and recommends a new vaccine each year against the most dominant strains. For 2018-19, WHO has recommended the quadrivalent vaccine, which protects against A/michigan H1N1, A/singapore H3N2; B/colorado (B/victoria lineage), and B/phuket (B/yamagata lineage).

While several developed countries recommend everyone get vaccinated against the dominant flu strains, Dr Guleria recommends prioritising vaccination to protect people most at risk. These include pregnant women, where vaccination protects the mother, the foetus and the newborn up to six months after birth; people with who are immune-compromised because of chronic medical conditions such as respiratory diseases, heart disease, diabetes, cancer, renal failure, liver cirrhosis and neurological conditions; and health professionals in transplantation and oncology wards.

“All health workers must get vaccinated as they risk infecting immuno-compromised patients. I ensure everyone in my department gets vaccinated every year, I got my flu shot while I was treating patients in OPD,” said Dr Guleria, who is a professor of pulmonology at AIIMS and a member of the World Health Organization’s Scientific Advisory Group of Experts on immunization and influenza vaccination for emerging markets.

Seasonal flu outbreaks have two peaks in India, once post winter from January to March, and the second from July to September.

“Most people have no complications, but the ones at risk must be protected with vaccination,” said Dr Prasad, who advocated a single vaccine for the world, instead of two different ones approved by the WHO for the northern and southern hemisphere.

“With growing population, rapid urbanisation and mass transport, viruses travel across hemispheres within a few hours. Infection is no longer seasonal and people are at risk 365 days a year. I recommend annual flu vaccination for people at risk all through the year,” said Dr Prasad.