Incorrigible demon

In what comes as a major setback for the health authorities of India, at least 12,500 people have been diagnosed to be infected with the influenza A (H1N1) virus this year, of which 600 have died. The official figures said that Maharashtra alone has registered 284 deaths, which by itself is much more than the total mortality figure of 265 in the country as a result of H1N1 in 2016. Even in the first three months of 2017, the number of cases and deaths were higher than expected, i.e. over 6,000 and 160 respectively. And, if the 'cooler the temperature, higher the chances of Influenza' theory is to be believed, there is every possibility of a spike in the number of cases in the coming months with cooler temperatures setting in. Though the incidents of H1N1 are likely to be less than in 2015, when the death toll was about 3,000, still the steady toll being swept by 'swine flu' is a big cause for concern. The whole genome sequencing was carried out at Pune's National Institute of Virology and it has confirmed that the virus has not undergone any significant mutation to make it more virulent. The virus has undergone point mutations, which is normal and reflects its evolution, but this has no correlation with virulence whatsoever. While the California strain had been circulating around the world since the 2009 H1N1 pandemic, a new strain — the Michigan strain — emerged last year as a result of point mutations. India witnessed the circulation of both the California and Michigan strains in 2016. This year, surveillance revealed that the H1N1 virus found in India is only the Michigan strain.

As in the case of the California strain, the Michigan strain too is susceptible to the drug Oseltamivir. In order to make the drug widely available and easily accessible to ensure early treatment, the drug was moved from Schedule X to Schedule H1 last month. Timely diagnosis with an easy and wide availability of the drug is expected to reduce mortality. It could also potentially increase the risk of drug resistance setting in earlier. There are 42 laboratories providing diagnostic services across the country and there is a compelling need to increase this number. The prime reason is that any delay in receiving results from reference laboratories combined with ready availability of the drug in more pharmacies would result in more prescriptions being handed out even in the absence of a confirmed laboratory diagnosis. Since the 2009 epidemic, H1N1 has become a seasonal flu virus strain in India even during the peak of summer. As a result, the only way left is to reduce the number of cases and deaths is by framing a national policy for influenza immunisation. The first step in that direction is to have qualitative and quantitative data on the vulnerable population. On the other hand, vaccinating health-care workers who come in contact with high-risk patients should also be a priority.