Where is the pandemic headed? Is the worst yet to come?
The pandemic is expected to further spread and in wider geographic areas. As the number of cases increase, so will the proportion of severe manifestations within the larger pool of moderate disease and silent infections. Occurrence of severe cases of illness cannot be assumed to be due to the virus becoming more virulent, the evidence for which is being monitored by the competent national laboratories.
Will a vaccine be ready in time? If it is, who will get priority?
The vaccine for pandemic H1N1 influenza is likely to be available by the year-end according to manufacturers. The Government of India would be determining this prioritization for vaccination. It is assumed that health care workers, staff responsible for essential services, people with co-morbid conditions and pregnant women would be included in the initial phases.
Are deaths higher among healthy, young people?
At present, there is no evidence of high fatality among young adults. The fatality is relatively higher among people with underlying health conditions such as cardiovascular disease, chronic respiratory diseases including asthma, diabetes, obesity and conditions such as cancer and renal disease with immune suppression.
Overall, the disease remains moderate. Of the around 134,503 laboratory confirmed cases there were 816 deaths. Hence, so far, the fatality rate is low. Furthermore, such a rate will be even lower if the real number of influenza is counted since the 134,503 cases is the tip of the iceberg. Globally there is a much larger pool of silent infections and / or moderate unrecognized symptomatic cases. Also it is pertinent to state here for comparison that seasonal influenza is responsible for an estimated up to 500,000 deaths annually.
If you get the pandemic H1N1 influenza will it give immunity in future?
Yes, for the specific viral strain.
When should parents and individuals insist on getting tested?
The experience globally so far shows that in most people the infection has been mild and they have completely recovered even without antiviral treatment. There is also a much larger pool of silent infections and / or cases with moderate unrecognized symptoms.
However, it is recommended that people with serious illness and co-morbid conditions report to designated hospitals and seek treatment. People with severe symptoms such as rapid breathing, breathlessness, fall in blood pressure, chest pain, loss of consciousness and those in whom fever and respiratory symptoms subside but recur after an interval, should seek treatment at the designated hospitals.
With time, it is expected globally that the disease will continue to spread now and during second expected wave. Hence home care should be encouraged.
What precautions should the government take?
The Government of India has taken commendable measures, including stockpiling and provision of medicines, facilitating laboratory work, provision of testing kits, activation of national preparedness plans and further training of the rapid response teams in the country.
The measures approved by the Inter-Ministerial Task Force (IMTF) to reduce the speed and geographic spread of the virus included screening of cases at entry points and establishment of systems for easy self-reporting of illness. Suspected cases are being admitted at designated hospitals for testing, isolation, treatment and follow up. Contacts of cases are being traced, quarantined and provided preventive treatment (prophylaxis).
Health care facilities in the states under the country’s Integrated Disease Surveillance Project and medical colleges have been activated to report on Influenza like Illness (ILI) and Severe Acute Respiratory Infection (SARI) /Pneumonia cases.
As expected globally, the virus continues to spread, and now, the government is focusing on measures to mitigate the adverse impact of the illness as planned. The Government is also facilitating processes for the production of vaccines by manufacturers, stockpiling and provision of anti-virals, equipment and other medical supplies needed for treatment of severe cases and infection control.
The Government is already communicating risks, personal protective measures and preventive guidelines through the mass media. The Ministry of Health and Family Welfare is rolling out a structured media campaign on preventive behavior for flu, what people should do in the event of flu and to whom to report to.
WHO is collaborating with the Government of India for rapid augmentation of the country’s capacity to implement mitigation measures for the pandemic. Under the leadership of the Union Government states have been building capacity for pandemic influenza preparedness for the last two years. As part of capacity building for Avian/Pandemic Influenza, a large series of workshops, refresher training for epidemiologists and microbiologists, and table-top exercises have been conducted to test response plans of each state. Clinicians and anesthetists and have been trained on clinical management. The states have been supported to undertake capacity building and trainings at the district level for public health professionals, clinicians, anesthetists and microbiologists and on the district level influenza preparedness, rapid response teams and management of cases.