H1N1 has killed 1,059 people in India since the first infection was confirmed in Hyderabad on May 16 last year, but the worst is over.
Experts tracking the pandemic say it has been showing signs of waning, both in India and the world. The number of new cases has steadily fallen in India over the past two weeks, with only 33 H1N1 cases confirmed on Sunday, as compared to 225 just two weeks ago, on December 25, 2009. There were five deaths in the country on January 10.
The states worst-hit have reported a fall in new infections. On January 10, Delhi added only 14 cases — after averaging 15 over the past week — to its tally of 9,555, and two new cases were added to Karnataka’s 1,927. No cases were reported in Maharashtra, with 4,732 cumulative cases, and Tamil Nadu, with 2,071, or Kerala, with 1,456 cases.
Even after factoring in infection-breakers such as closed schools and cold weather preventing new infection, scientists tracking the data say that as pandemics go, H1N1 is turning out to be a mild one. Most people recover without needing hospitalisation or even developing severe symptoms, such as breathing distress or shock.
“H1N1 has become as ubiquitous as the common flu, causing high fever for a day or two, which usually comes down even before H1N1 is confirmed,” said Dr Subhash Arya, chairman of the department of pediatrics and adolescent medicine at BLK Memorial Hospital in central Delhi.
The case of Anya (6), daughter of Madhulika Sapra (38), bears it out. Anya developed fever, with the temperature touching 103 degree Celsius on January 2, and when paracetamol did not bring the temperature down, her mother got her tested for H1N1 at a private lab the next day.
The results confirmed Anya had H1N1, but by then her temperature had become almost normal.
“The paediatrician said the infection was self-limiting and it would go away on its own. He said she did not need treatment, so we did not give her any anti-flu medications such as oseltamivir (brand names Tamilflu, Fluvir),” said Sapra, an East of Kailash (South Delhi) resident.
Dr Arya too prescribes oseltamivir with caution. All he asks parents to do is to keep children at home for a week to prevent them from infecting others and track people they have been in contact with for serious symptoms of flu.
The health ministry data for November show that the H1N1 infection has been mild and has killed 2.4 per cent of the people infected, with the maximum deaths — 4.8 per cent – in the 20-39 age group. Though the virus flourished in schools, deaths among 5-19-year-olds in India remained a low 0.8 per cent.
“There were more deaths initially because awareness was low and everyone, including doctors, was caught unawares. Now that people are getting diagnosed and treated in time, the number of hospitalisations and deaths has fallen,” said Dr V.M. Katoch, director general of the Indian Council of Medical Research, and secretary, department of health research, Union ministry of health.
People above 55 years are at a lower risk of infection because they are likely to be immune to the virus. “The viruses that circulated 50 years ago are more closely related to the swine-origin H1N1 viruses than are present-day seasonal flu viruses, so older people have some immunity,” said Dr Katoch.
The government’s screening centres, however, are testing and prescribing oseltamivir to everyone with flu-like symptoms. To date, 27,712 (23.6 per cent) of the 117,094 persons tested for H1N1 have been found positive.
“Everyone with flu-symptoms doesn’t need to be tested or treated, but government hospitals rarely turn people away. At this stage, infection is actually good as it builds community or herd immunity and leads to a long-term fall in infection rates, as it happened in Pune, where 20-30 per cent of the population developed immunity after the August outbreak last year,” said Dr Katoch.
“It is quite possible to have a pandemic on the milder side. And if we are experiencing that and the number of serious cases is kept down, it is something for which we should all be thankful,” said Dr Keiji Fukuda, special adviser on pandemic influenza, WHO, Geneva.
He, however, cautioned that the virus could undergo a major mutation to become more deadly.
Worldwide, H1N1 has caused at least 12,220 deaths in 208 countries till December 31, 2009. The numbers are low compared with previous pandemics, such as the 1918 Spanish flu, which killed 20 million and infected up to 40 per cent of the world’s population, or even the far less deadly 1957 and 1968 flu outbreaks, which killed and hospitalised many more.
With Ahmedabad-based Zydus Cadila becoming the first pharmaceutical company to get the Drug Controller General of India’s nod to conduct multicentric clinical trials of its vaccine last week, an indigenous vaccine should be available at chemists by June.
“Till then, 1.5 million doses of the imported vaccines from Sanofi Pastuer are arriving this month to vaccinate frontline workers,” said Dr Katoch.