In an overpopulated, economically challenged country like India,  any infectious disease, can raise its ugly head to epidemic proportions.

Swine flu (H1N1)  in India is cause for worry due to the virulent nature of the virus. The public panic and terror about the disease are partly justified. Lack of awareness and extreme challenges of collecting data for surveillance has focused the world’s eye on India’s battle with the beast “swine flu”.

With the infection spreading by sneezing, coughing and close contact and the virus randomly combining with bird and pig influenza virus to produce new virus strains, it’s a science-fiction horror story unfolding at a rapid pace.

 Swine Flu: Why do you catch it?

• Unusual prolongation of the winter season
• Lack of enough authorized testing centers
• Failure to rope in private-sector health care facilities adequately to handle the emerging epidemic
• Limited timely  availability even in metro cities and Government setup
• Lack of Public awareness regarding the disease, vaccination, and treatment
• Possible major antigenic change in flu virus genetic makeup

 Swine Flu Prevention

1. Flu vaccine to people at risk urgently
2. Dedicated Flu OPDS at all government and private health care centers.
3. Reservation of Isolation beds for Swine flu cases at all government and private hospitals
4. Increased number of  Private and State-run testing centers
5. Improved availability of flu drugs
6. Flu drugs are given only with a prescription
7. Public Health awareness drives to promote awareness, prevention, testing, and treatment.
8. Maintain hand hygiene and personal precautions.

Symptoms of swine flu are similar to the common cold. But there is an increased risk of complications, especially in the very old and very young.

Swine Flu Symptoms: What happens if you have swine flu?

• High-grade Fever  with chills and rigor
• Muscle pain
• Cough
• Nasal Secretions
• Fatigue
• Headache
• Bodyache
• Sore throat
• Nausea, Vomiting, dizziness, diarrhea
• Respiratory distress
• Need for intensive care in severe cases

Treatment of Swine Flu (H1N1)

 The best treatment is prevention.

• Vaccination
• Personal protection, preventive care
• Drugs
• Supportive care

Swine Flu Vaccination

Who needs it: Risk group

According to  CDC Recommendation, it is best practice to vaccinate the following groups of patients

1. Children 6 months to 59 months/4 years and 11 months.
2. Adults > 50 years.
3. Adults and children with chronic pulmonary, cardiovascular, renal, hepatic, metabolic, hematologic, disease.
4. Immunosuppressive patients including HIV.
5. Women of reproductive age group planning pregnancy in this period and pregnant women.
6. 6 months to 18-year children who are receiving long-term aspirin therapy.
7. All Healthcare professionals.
8. Household contacts and caregivers of people at high risk for complicated influenza, and caregivers of children. younger than 5 years and especially less than 6 months.
9. Residents of chronic care facilities.
10. American Indians, Alaskan natives.
11. Morbidly obese people.

 What is a flu shot?

• Intramuscular vaccine(given in the arm muscle with a syringe and needle)
  flu shot

• Trivalent (commonly), this means it will contain antigens (infection causing protein particles), from the three most common strains of virus causing influenza. Generally, it will have antigens belonging to  Type A  subtype H1N1, Type A subtype  H3N2, and Type B virus antigens.
• Now Quadrivalent vaccine (Type A subtype H1N1, Type A subtype  H3N2  and type B Victoria lineage and Type B Yamagata lineage, is also available in India.
• Composition: killed vaccine.As the virus in the vaccine is killed it will not cause swine flu in any patients.

 Contraindication to flu vaccine:

1)Anybody with an allergy to eggs. Flu virus particles are cultivated in egg cells and are not given to people with egg allergy as it can cause a severe allergic reaction.

2) Previous history of severe reaction to the flu vaccine.

3) Anybody with moderate to severe illness with a fever should wait at least till fever subsides.

4) History of GBS (Guillain-Barré Syndrome, a condition where your bodies immunity may attack its own nervous system

The dose of  vaccine :

0.25ml  for 6 months to 3 years

0.50ml for  more than 3 years

 Timing:

It is a yearly vaccine and needs to be given every year before flu season. Preferably October onwards, and as soon as feasible. It takes 2 weeks for an adequate level of protection to be reached and you are at risk during this period.

Whether your child will need one or two doses will be best advised by your doctor.

But CDC recommends:

6 months to 8 years: 2 doses of vaccine > 4 weeks apart during their first year of flu season.

The first dose should be offered as part of routine vaccination to avoid missing the chance to provide adequate timely protection.

Opportunity for vaccination should ideally be given to all children as long as flu season persists.

Complications of Swine Flu vaccine

They include soreness, minor swelling, and redness at vaccine site, low-grade fever, nausea.

What is the vaccine efficacy against the current swine flu virus?

Influenza vaccines are intended to give protection against the most likely flu viruses (as determined by scientific research), which might cause influenza during the next flu season.

Shockingly CDC says the vaccine efficacy keep changing.That’s a big worry.The reason being that 70% of the circulating H3N2 viruses have major genetic variations (antigenic drift) which are different from the virus strain in the vaccine.

But you still need to vaccinate because

• Prevents infection and complications, from the circulating H3N2 Virus which might not have changed.
• May protect against other influenza virus infection like H1N1 and Influenza B

Can you get swine flu even after vaccination

Unfortunately yes.It’s possible as:

• You might be infected shortly before vaccination or within the time period it takes for adequate immunity to develop(generally it takes at least 2 weeks to be properly protected, and the protection gradually becomes less   as the time following vaccination increases.)
•  You might be infected with an influenza virus not included in the Trivalent vaccine (There are many varieties of the flu virus, the vaccine includes the most common ones causing flu)
• People who have chronic diseases, very young children, and old people may not be totally protected. Some of them may still be infected with the influenza virus included in the vaccine.

This occurs as the protection provided by the flu shot, is best in healthy young adults and older children. Protection varies with age, general health, and other coexistent diseases.

Nasal spray vaccine

Not popular in India. It has the following features:

1. Live virus
2. An intranasal spray containing the virus sprayed into the nasal cavity
3. Recommended in 2 years to 49 years, healthy people.
4. Single Dose
5. Composition the same as that of an intramuscular flu shot
6. A similar level of protection

Contraindications of nasal spray vaccine (as recommended by CDC)

•  People with depressed immunity
• Having egg allergy
• Previous history of GBS syndrome (Guiallane -Barre syndrome)
• Children <2 years and  more than 49 years
• Children 2 years to 17 years taking aspirin.
• History of antiviral drugs being taken orally within the last 48 hours.
• Past history of allergy to flu vaccine /its components.
• History of chronic respiratory disease like asthma, with an episode of wheezing within the last 12 months
• Pregnant women

Conclusion

India has a population of 1.27 billion with most cities being overcrowded. What works in western countries may largely not work here, due to the socio-economic, cultural and educational background.

But whatever our drawbacks, if you can follow the personal care precautions and get vaccinated you are halfway prepared to fight the disease. Rest is God’s will. Vaccination and personal safety precautions are still our best chance of protection.

March  2015 

According to the data available with the Union Health Ministry, 2167 unfortunate people have lost their lives to this disease.35077 people have fallen ill with  Swine flu till date.Gujrat has been the worst affected with the death toll being 467 according to  The   Hindu.

Even though Delhi and Tamil Nadu both have been reporting a high number of cases, the death toll was not as high due to better public awareness and healthcare infrastructure.

Outbreaks of Swine flu had started since late 2014 in India. Increased ability of the H1N1 virus to cause infection, has been forefront among the many reasons for such a prolonged and severe Flu season.

MIT researchers have claimed that the Indian strain is a more virulent variety of H1NI.A  mutation causing changes in the Haemagglutinin protein has been cited as a probable cause of increased virulence.Indian researchers have however challenged this claim by saying that their research doesn’t show any such variation in the genetic nature of H1N1.

Update May 2017

Swine flu has claimed 160 lives in various parts of the country till March. Minister of State for Health Anupriya Patel in a written reply in Lok Sabha said between January 1 to March 26, 160 people died from swine flu, while 6,062 cases were registered(New Indian Express)

A total of 844 cases reported in  Maharashtra   DNA NEWS.

H1N1 influenza has claimed 23 lives in Kerala so far in 2017, a total of 300-400 swine flu.(DNA news). In 2016, more than 12 lakh children less

In 2016, more than 12 lakh children less than five died in India. Of these deaths, pneumonia caused more than 1.7 lakh deaths and ” Dr. VK Paul, Department of Pediatrics, AIIMS.(DNA news).That’s the problem with swine flu in children.They just can’t cope.

Updated August 2017

• 17 people have died in Vadodara.As on 21st August 🙁source)
• A total number of swine flu positive patients within VMC limits is  400. 242 have been cured, 17 have died the condition of 133 patients is stable, eight patients are on a ventilator.
• Maharashtra stats  (source):414 deaths and 4,014 cases.Maharashtra reported   50% of all H1N1 influenza casualties and one-fourth of the confirmed cases in India since January.
• 280 suspected cases of swine flu have been reported in Punjab.75 cases were positive and 15 mortality.
• H1N1 increased three times this year.18,000  affected. 871  deaths across India so far.Last year 1,786 cases and 265 deaths.

Originally published in 2015. Updated with current data on  February 2019

This year in India  6,701 cases of spine flue was recorded and 226 confirmed mortality till February 3rd.

Last year it was 798 cases and 68  mortalities.

Also, read

Cold or Flu

Flu vaccine that protects against all type of Flu

6 things you must know about Flu vaccine!

Ultimate Nutrition tips to fight Flu and improve immunity

Everyday Practices to Prevent Swine Flu

Meningitis in Children:What you need to know

Meningitis facts you can’t afford to ignore as a parent

How to choose Meningococcal Meningitis vaccination

Nipah Virus India

MR vaccine drive 

Ebola virus

Rotavirus vaccine: Do your children need it?

Disclaimer: This is information for awareness.As healthcare information is constantly updated, the blog post is not meant to be a replacement for a doctor consultation, nor is it a medical recommendation or treatments.Any reader of this blog, with problems, should specifically consult his/her doctor for medical conditions and follow the suggested course of treatment’.

Reference:

1) CDC Swine flu

2)Hindustan Times

3)Harrison: Principles of Internal Medicine

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