As swine flu numbers soar by 17 times, how safe are you?
Prevention and awareness are key as the highly contagious disease affects people across age groups and delayed diagnosis becomes a major cause of a rising death toll.health Updated: Sep 17, 2017 07:59 IST
Her first pregnancy went so smoothly that Archana Panigrahi, 34, foresaw no problems with her second.
But then she contracted a fever last month, during her fourth month, which quickly escalated to breathlessness and chest pain.
“On the second day of the fever, my blood pressure fell and my husband rushed me to my gynaecologist, who immediately referred me to a hospital emergency ward,” recalls Panigrahi, a teacher at a private school in Gurgaon.
She was diagnosed with H1N1, also known as swine flu. “I was terrified that I would lose my baby, but I responded to antiviral treatment and was home in five days,” Panigrahi says. “It was only at my next follow-up that the doctor told me the situation had been touch-and-go… he says if I had waited even a few more hours, I would have lost my baby and perhaps my life.”
Unlike in most countries, where children under 5 years and adults over 65 are at greatest risk of contracting swine flu, H1N1 is infecting adults in India.
“Those aged 20 to 60 are also being hospitalised, often because they were diagnosed late,” says Dr KK Aggarwal, president of the Indian Medical Association (IMA).
Does this mean everyone with fever or a cough needs to be tested?
No, says Dr Agarwal. “Current IMA recommendation is ‘no fever, no flu; no breathlessness, no testing’. If you have a cough without fever, it’s not seasonal flu, and if you have fever without breathlessness, you don’t need to get tested for H1N1,” he said.
Instead, he adds, the focus must be on prevention.
“People at risk must get vaccinated and, if they develop symptoms, get treated with antiviral drugs to lower their chances of developing potentially life-threatening complications,” says Dr Malvika Sabharwal, gynecologist and obstetrician at the Nova Specialty Hospitals of the Apollo Healthcare Group, New Delhi. “The key is management, which can be done at home, if it’s done right.”
Shot of life
Swine flu is a highly contagious disease that causes symptoms of fever, cough, breathlessness, lethargy, headache and nausea.
Most people recover within a week, with deaths occurring from complications such as pneumonia and multi-organ failure in people at risk, such as children with respiratory problems, pregnant women, older adults and those with chronic ailments such as asthma, lung disease, heart disease or diabetes.
With H1N1 cases up 17 times this year as of September 10, the last date for which all-India data is available, physicians are saying annual vaccination is now a must for people at risk.
“Getting vaccination annually reduces symptoms, shortens the duration of the illness and lowers doctors’ visits and flu-related hospitalisations,” says Dr Aggarwal.
Since several different viruses cause symptoms of flu, the World Health Organization recommends a new vaccine each year that targets three to four of the most deadly flu strains causing infection, based on flu-tracking data from 143 National Influenza Centres in 113 countries, including India.
If the viruses causing infection change, so does the recommended vaccine.
“I strongly recommend the quadravalent flu vaccine to women planning to conceive and to all pregnant women, preferably in the 26-week of regency, so it protects the mother and baby for six months after birth,” said Dr Sabharwal. “The vaccine cannot be given to babies younger than six months, so vaccinating the mother during pregnancy gives protection to the baby after birth.”
Prevention is the only way to bring down infection and death rates, adds a Union health ministry official who did not want to be named. “India has extensive guidelines for vaccination and we’re now working to ensure people who need it get vaccinated.”
WARNING SIGNS: Breathlessness the key symptom, not high fever
Swine flu has devastated the most lives in Maharashtra, which accounts for 532 of India’s 1,586 H1N1 deaths. Experts blame the high number of deaths on delayed diagnosis and resultant complications.
Atypical symptoms are a major cause for delays in diagnosis.
“Temperature is no longer a key indicator; sudden breathlessness is often the clue to H1N1,” says Dr Neeraj Tulara, consultant in internal medicine and infectious disease at Mumbai’s Hiranandani hospital.
Among his patients was 61-year-old homemaker Padma Jain, who developed a fever of 99 degrees Celsius followed by an upset stomach and vomiting. Her fever persisted for several days, but temperature didn’t go up, which led to the family delay going to a physician for several days.
By the time she reached hospital, her condition had deteriorated and she needed to be hospitalised for 20 days, 11 of which she spent in the ICU.
“I still feel weak but had I not been diagnosed, I know it could have got a lot worse,” she says.
Of the 500 or so suspected flu cases I have treated, at least 100 were swine flu, of which about 40 needed hospitalisation — which is double the number of admissions last year, says Dr Tulara, who also treated Jain. “Five of those cases needed extended stays in the ICU.”
On the upside, people with symptoms of fever and breathlessness are queuing up to get tested, willingly paying around Rs 6,000 for the test in the private sector. “Municipal corporation campaigns and media reports have raised awareness and led to an increase in the number of walk-ins for H1N1 testing,” Dr Tulara says.
- Anubhuti Matta