Saturday, February 21, 2015

India’s H1N1 Outbreak


Flu Strain Surveillance February 5th 2015  - Credit WHO


# 9735

While North America and most of Europe have been dealing almost exclusively with a `drifted’ H3N2 dominated flu season, parts of the Middle East and much of the Indian sub-continent have seen more of the A(H1N1)pdm09 virus this winter.


By nearly all accounts, essentially the same H1N1 virus that emerged in 2009, and that we saw return in the 2013-14 flu season.

Once considered a `pandemic’ flu, H1N1 is now viewed as a seasonal strain of influenza – and while it tends to strike a younger cohort than does H3N2 – it often produces a `milder’  overall flu season than H3. 


In the Indian press, however, H1N1 is still widely regarded as `swine flu’  or `pig flu’, and it isn’t unusual to see a heightened level of `urgency’ in their reporting on the virus.  This is ground we’ve trod before.


In 2012 (India’s last H1N1-heavy flu season) we saw a flurry of newspapers headlines (see Indian Expert: `Nothing Scary About Outbreak’), claiming government cover-ups of huge numbers of `swine flu’ deaths, and speculation that some (unidentified) `mutation’ in the H1N1 virus has revived its ferocity.

So prevalent were these stories that the Indian government issued a flat denial in April of 2012.


No Cause for panic about Pandemic Influenza A H1N1

Ministry of Health and Family Welfare

11-April, 2012 13:53 IST

The situation with respect to instances of H1N1 is well under control and is being monitored. As reported in some section of the press, the virus has not mutated to a more virulent form or changed its character.

(Continue . . .)


After a relatively quiet 2013-14 flu season, India is once again reporting high numbers of H1N1 cases and deaths, and the Indian and International press are giving it a lot of coverage.


Swine Flu Outbreak Kills 700 in India – Time

40 more deaths due to swine flu; number of cases cross 11000 mark - International-Times of India-Feb 19, 2015

Indian health officials urge calm as swine flu outbreak spreads – Al Jazeera


Although the numbers seem high (and undoubtedly represent only the smallest tip of much larger iceberg), in a nation of 1.25 billion people – tens of millions would be expected to contract the flu in an average year - and of those, tens of thousands would likely die.  


So it isn’t at all clear at this point that anything unusual is going on with the H1N1 virus in India. 


Despite persistent rumors to the contrary , India’s National Institute of Virology (NIV) and their National Centre for Disease Control (NCDC) both report No mutation of H1N1. That said, the  Health Ministry issued the following statement earlier this week, pledging an investigation.


Health Ministry on H1N1: Closely monitoring the situation; no shortage of drugs



As we’ve seen previously, India’s free-wheeling press isn’t shy about using infectious disease concerns to embarrass or discredit  local officials and even political parties. Over the past couple of days the Mayor of Mumbai and West Bengal’s Chief Minister have both come under fire for making what are – admittedly – some very strange assertions regarding the flu virus.


This from NDTV.

After Mamata Banerjee Thought it's Mosquito-Borne, Mumbai Mayor Calls Swine Flu a 'Heart Disease'

Mumbai | Veer Arjun Singh (with inputs from PTI) | Updated: February 19, 2015 23:19 IST


At the time when swine flu cases in the country have crossed 10,000 mark, Mumbai Mayor Snehal Ambekar today called it a "heart disease" and made a bizarre suggestion that the municipal authority will plant trees to check the disease.

"Swine flu is a heart disease... Hence, BMC will plant trees, develop gardens and parks to check swine flu," Ms Ambekar told reporters after garlanding the statue of Chhatrapati Shivaji Maharaj on the occassion of his birth anniversary in Mumbai today.

The blooper from Ms Ambedkar comes a day after West Bengal Chief Minister Mamata Banerjee was quoted saying that swine flu "mostly happens from mosquito bite".

(Continue . . .)



While it is always possible that the H1N1 virus could pick up changes that could make it more virulent as it passages through millions of hosts, this particular virus has proven remarkably stable since it emerged in the spring of 2009.


So much so that the A/California/7/2009-like virus is the same strain used in flu vaccines today. 


At some point A(H1N1) will drift antigenically enough as to render the old vaccine strain obsolete. The hallmark of flu viruses is that they eventually change, and H1N1 is no exception.


And while the concern is we’ll see a more virulent virus emerge, there is nothing that says H1N1 couldn’t just as easily evolve into a less virulent strain


Although India’s press reports on H1N1 are easy to dismiss based on their obvious hyperbole and oft times inaccurate description of the virus, anytime you have a large outbreak of flu it is worth keeping an eye on it.  

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