Insights into Editorial: Lessons not learnt: On swine flu

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Insights into Editorial: Lessons not learnt: On swine flu


h1n1-swine-flu

Background:

The infamous “Swine Flu” or the H1N1 Virus that infected 42,592 people in 2015 out of which it claimed the lives of 3,000 people, is back with a bang again. According to a disclosure by Health Minister in the Rajya Sabha at least 600 people had died due to swine flu as of July 9, 2017.

The virus that acts under swine flu is believed to be a variation of the influenza virus, usually showing similar symptoms as influenza like sneezing, cold, fever, headache, nausea, loss of appetite.

What is Swine flu?

A respiratory disease caused by a strain of the influenza type A virus known as H1N1.

  • The illness is originally known to affect pigs. It is known to have spread to humans who came in direct contact with pigs. However, the new virus or the mutated type of virus that has emerged over the years has the ability to affect humans without direct contact with pigs.
  • The virus is transmitted from person to person through the same medium as other flu viruses.
  • A healthy person may acquire the infection by inhaling droplets expelled by the infected person while coughing or sneezing or by contacting surfaces infected with the virus. The virus is not transmitted directly by eating cooked pork.

Risk Factors:

Since swine flu can directly be transmitted from one person to another through air droplets, people who fail to follow proper hygiene, especially in crowded places are at a high risk of contracting the virus. But, according to observations, there are specific groups of individuals that have been the most affected by the illness.

The group at a high risk includes:

  • Individuals having any other respiratory condition like pneumonia
  • Pregnant women
  • People suffering from chronic diseases like heart diseaseand diabetes
  • People more than 65 years of age and children younger than 2 years

These risk groups have been identified based on observation and doesn’t imply that you have swine flu if you have flu like symptoms and belong to any of the above risk groups. But, one should seek necessary medical care if you have flu symptoms.

Why is there an increased caseload and mortality this year compared with last year?

The number of influenza A (H1N1) virus cases and deaths reported from across India this year has already crossed 19,000 and 900, respectively. These are lower than the 2015 toll of 32,000 cases and 2,000 deaths, but the revived spread is alarming. In the last month or so there has been a sharp increase in the number of cases and deaths — over 6,000 and 300.

Gujarat is the worst-affected, with about 250 deaths recorded so far: Rajasthan, Punjab and Maharashtra and Delhi too have been badly hit. The number of H1N1 cases in the southern States is also high compared with last year, with Tamil Nadu reporting nearly 3,000 cases about a month ago.

  • According to the Pune-based National Institute of Virology, the virus has not undergone any significant mutation and the virulence has remained nearly unchanged.
  • It has however undergone point mutations which resulted in a new strain — the Michigan strain replacing the California strain that has been prevalent since the 2009 pandemic.
  • While both strains were co-circulating last year, as per surveillance data only the Michigan strain has been circulating this year.
  • The increased caseload and mortality this year compared with last year could be because pre-existing immunity through exposure to the California strain is no longer effective, and people are therefore not immune to the new strain.
  • More research is needed to fully understand the epidemiology of H1N1 caused by the Michigan strain, and who may be more vulnerable.

Evidence that India has not learnt any lessons from the 2015 H1N1 epidemic

  • Despite the high numbers, there is no system in place to release data periodically and frequently. Compare this with the regular updates provided by the U.S. Centers for Disease Control and Prevention, especially during an epidemic.
  • There has also been a failure on the part of governments to spread awareness about prevention strategies.
  • Uptake of influenza vaccination by people, especially by those belonging to the high-risk category, has been extremely poor, with only about 10,000-12,000 doses of H1N1 vaccine sold in the last six months by the Pune-based vaccine manufacturer.
  • Since the 2009 pandemic, H1N1 has become a seasonal flu virus strain in India even when the temperature soars during the summer months.
  • Vaccination of health-care workers and people in high-risk categories is the only way to reduce the toll.
  • That guidelines for H1N1 vaccination of people belonging to high-risk categories such as pregnant women, very young and old people and those with certain underlying illnesses were released only last month by the Health Ministry is evidence that India has not learnt any lessons from the 2015 H1N1 epidemic.

Urgent measures are needed to ramp up preparedness in dealing with epidemics.

Treatment:

Once the patient is tested positive for swine flu, treatment needs to be initiated immediately.

  • According to the National Institute of Communicable Disease (NICD), swine flu can be completely treated if it is diagnosed at a very early stage.
  • The anti‐viral medicines oseltamivir (Tamiflu/Fluvir) and zanamivir (Relenza) are given to diagnosed patients.
  • As per NICD, the medicine should be administered within 48 hours of the first symptom. The drugs work by inhibiting the ability of virus to release progeny virus particles.

Prevention:

Just like other influenza viruses, H1N1 infection can be prevented by practicing basic hygiene. Here are some tips to prevent swine flu:

  • Wear a proper surgical mask during flu season because the number of cases shoots up during the summers and monsoon seasons.
  • Always cover your face while coughing or sneezing. Ensure others around you also follow the same practice, especially if they’re down with cold.
  • Always wash your handsbefore and after eating and particularly after returning from a public place.
  • Remember the virus can also spread through droplets that have settled on surfaces so avoid touching them if you’re around a person who has flu like symptoms.
  • Avoid visiting unhygienic places or using public restrooms.
  • If you develop flu like symptoms or even feel sick, stay at home and take enough rest. Keeping away from others to prevent the spread of the infection.
  • Drinking lots of warm waterand fluids wash off the virus into the stomach where they cannot survive.

Way Forward

  • A range of administrative policies and practices can be used to minimize influenza exposures before arrival, upon arrival, and throughout the duration of the visit to the healthcare setting. 
  • Measures include screening and triage of symptomatic patients and implementation of respiratory hygiene and cough etiquette.
  • Information could be collected from different surveys and surveillances to:
    • Find out when and where influenza activity is occurring
    • Track influenza-related illness
    • Determine what influenza viruses are circulating
    • Detect changes in influenza viruses
    • Measure the impact influenza is having on hospitalizations and deaths in the United States
  • Our Government may follow the S. influenza surveillance system which is a collaborative effort between CDC (Centre for Disease Control) and its many partners in state, local, and territorial health departments, public health and clinical laboratories, vital statistics offices, healthcare providers, clinics, and emergency departments.
  • Facilitate prompt awareness and characterization of influenza-A viruses with pandemic potential and accelerate the implementation of effective public health responses.