Replying to an unstarred question, Health Minister J P Nadda informed Rajya Sabha on Tuesday that 600 people had died of H1N1 infections until July 9 this year, nearly half of them — 284 — in Maharashtra. The death toll in the state so far this year is higher than the number of deaths from H1N1 in the whole country in 2016 — 265.
So, what is H1N1, and why is it killing so many people?
The H1N1 variant of the flu virus is commonly — and in the present case somewhat erroneously — known as “swine flu virus” because it was known in the past to occur in people who had been in the vicinity of pigs. That is no longer true — the virus in its current form affects and spreads to people who have got nothing to do with the animal. It is essentially an infection of the respiratory tract characterised by the usual symptoms of flu — cough, nasal secretions, fever, loss of appetite, fatigue and headache. In 2009, when H1N1 was spreading fast in many countries around the world, the World Health Organisation called it a pandemic. Since then, people have continued to get sick from swine flu across the world, including in India, but the cyclical nature of the virus means that every few years there is a spurt in cases and deaths.
What is the current H1N1 situation in the country?
Until July 9, 12,460 people have been infected, and 600 have succumbed to it. This is much more than the 2016 tally of 1,786 cases and 265 deaths, although it is nowhere near the outbreak of 2015, when 42,592 cases were reported and close to 3,000 people died. This year, Gujarat has recorded 75 deaths from 289 infections; Kerala, 63 deaths from 1,127 infections, Rajasthan, 59 from 407 reported cases; Karnataka 15 in 2,377 cases; Telangana, 17 deaths from 1,443 cases; and Tamil Nadu, 15 from 2,896.
Why does swine flu strike in cycles?
The present strain of H1N1 emerged in 2009, so it is still a relatively new entrant in the influenza virus pool. Until the time it “stabilises”, as epidemiologists call it, and integrates into the seasonal virus pool, this cyclical recurrence will happen. This will go on until the process of antigenic shift — by which two or more strains of a virus integrate into a new subtype — is completed. The influenza virus goes through an antigenic shift every few years. As and when the process of emergence of the new phenotype is completed and a critical mass of the population develops a “herd immunity” (as a result of exposure to the virus), that the virus will “stabilise”. It will then become just one of the many viruses that cause seasonal influenza, and its impact and fatality would both gradually subside. How many years this process takes is not documented, though.
What steps has the government taken to control the situation?
On June 22, Oseltamivir, the drug for the treatment of H1N1 influenza, was moved from Schedule X to Schedule H1. This means the drug which could be hitherto stocked only by select authorised pharmacies, can be sold by all licensed chemists under prescription, thus ensuring its wider availability and accessibility. The original decision to put Oseltamivir in Schedule X had been taken to prevent resistance. Twelve laboratories under Integrated Disease Surveillance Programme (IDSP) and 30 laboratories under the Indian Council of Medical Research (ICMR) are providing diagnostic services for detection of the influenza virus to states. The Ministry of Health and Family Welfare has procured laboratory diagnostics (to test 20,000 samples) for the labs in the IDSP and ICMR networks. How hard H1N1 strikes is in many cases a function of awareness and preparedness. So, Delhi has reported 241 cases but only four deaths, while Gujarat has seen 289 cases and 75 deaths. It is also a function of living conditions — the more people are exposed to crowded places or unhygienic living conditions, more are they likely to contract the infection.
Some basic influenza do’s and dont’s are applicable to swine flu too. These include covering the mouth or nose while coughing and sneezing, washing hands frequently, avoiding crowded places, maintaining a distance from a person suffering from flu, avoiding handshakes, etc. Do not self-medicate.