The fever is down

The flu is back,but without the scare. One year after the H1N1 virus led to the first death in India,and set off a wave of panic across the world....

The flu is back,but without the scare. One year after the H1N1 virus led to the first death in India,and set off a wave of panic across the world with cities reporting closure of schools and public areas seeing a drop in numbers the onset of monsoon has seen a fresh spurt. In the month of July alone (till the 25th),38 deaths had been reported due to swine flu,and experts say the numbers are likely to go up. However,with vaccines in hand,H1N1 is no longer seen as a killer but is on course to being treated as any other seasonal flu.

According to health experts,within this year,they expect almost everybody to have been infected with the virus at least a mild version. What also gives credence to this theory is that a year after the first wave,the cases that are being reported are more and more indigenous,meaning victims with no travel history to flu-affected countries.

The cases are definitely going to go up and spikes will come,but then there is also a hope that it will stabilise this year itself, says Dr V M Katoch,Director-General,Indian Council of Medical Research (ICMR).

The last peak seen was in winter,when 80 people had died of swine flu in the country in December alone. In fact,Indias mortality rate for the virus in September last year was 2.3 per cent much above the 0.9 per cent rate for the rest of the world. The virus is peaking again now as the drop in temperature provides it a conducive atmosphere to breed.

A long-term study is currently on by the Indian Council for Medical Research (ICMR) and National Centre for Disease Control (NCDC) on the trends of the virus. It shows that H1N1 continues to affect the economically productive age group. A senior Health Ministry official said that up to 40 per cent of the infected population is between 20-45 years of age,while children between 5-15 years comprise another 30 per cent. The other high-risk group are pregnant women 21 of whom have died in Kerala in the second wave as they currently cannot be given any of the vaccines developed against H1N1.

At the same time,these vaccines are finding few takers among the general populace as well in what could be another sign of the swine flu scare dying a gradual death. According to data available with the Union Health Ministry,states such as Maharashtra,Delhi,Uttar Pradesh and Rajasthan have not got even their frontline healthcare workers vaccinated.

The Ministry had earlier this year imported lakhs of doses of H1N1 vaccine from French company Sanofi Pasteur and sent them to states so that workers at risk of getting infected could take the shot. Maharashtra,one of the worst-affected states,has found health workers reluctant to take the vaccination. Of the 34,000 doses sent to it,only 242 doses were administered.

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Delhi was given 19,800 doses of the vaccine,of which only 2,400 were used. Orissa used only 5 per cent of the vaccines sent to it,while Manipur used less than 1 per cent,UP 17 per cent,Chandigarh 15 per cent,Himachal Pradesh and Rajasthan 27 per cent each and Madhya Pradesh 12 per cent.

According to the Ministry,only eight states used at least 50 per cent of the vaccines sent to them Arunachal Pradesh (97%),Daman (92%),Tamil Nadu (77%),Chhattisgarh (68%),Gujarat (67%),Andaman (65%),Punjab (62%) and Lakshadweep (51%).

While a concerned ministry even wrote to chief ministers a month ago asking them to take up the vaccination seriously,officials say they have seen no change in the trend.

The authorities are also no more concentrating their energies on containment,which last year included measures like screening travellers at airports,but focusing on treatment. Officials point out that containment counts for little when the H1N1 virus has already penetrated a large population of the country.

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The treatment pattern has also shifted towards advising home quarantine to more and more people testing positive for swine flu,instead of admitting them in hospitals. Only those who are very sick and who have associated high risk or co-morbid conditions are being admitted.

Earlier we were trying prevent the transmission or the spread of the disease but now that it has spread,the focus has shifted more to reaching the sick and preventing higher mortality and morbidity, Dr Randeep Guleria,professor of medicine,All India Institute of Medical Sciences (AIIMS).