The State Health Department is preparing to broaden surveillance strategies in the wake of the rise in number of cases of A (H1N1) influenza reported from within the country (indigenous cases), which could easily result in increased spread across State borders.

Till now, the airports were considered the primary check-posts for A (H1N1) screening of those arriving from other countries who have flu-like symptoms. Now that the fear of local spread of the virus is real, the risk of the virus spreading through crowded railway stations and even bus stations is real.

The authorities anticipate that many Keralites settled in Mumbai and Pune will visit the State during the Onam festival. “It is unreasonable and impractical to think about setting up screening counters at railway stations. It is resource-intensive, and unlike airports, there are no common entry or exit points where we can screen all passengers. What about people who enter the State by road? We can only give the message to the public that anyone who may have been exposed to the virus should voluntarily come forward for testing,” Amar Fettle, State nodal officer for A (H1N1) virus, said.

He said that on the recommendation of the WHO, many countries with widespread community transmission of A (H1N1) have moved to testing only samples of ill persons and have shifted surveillance efforts to monitoring and reporting of trends. The counting of individual cases is no longer essential in such countries for monitoring the level of risk or to guide response measures.

The WHO has recommended this shift because “as the pandemic progresses, monitoring trends in disease activity can be done better by following trends in illness cases rather than trying to test all ill persons, which can severely stress national resources…”

The focus of surveillance activities will thus shift to reporting against the established indicators for the monitoring of seasonal influenza activity.

The State thus needs to improve the surveillance of Influenza-like Illnesses (ILI) and Severe Acute Respiratory Infections (SARI), which are two indicators of heightened influenza virus circulation in the community.

The Union Health Ministry has already given instructions that all healthcare facilities in the State under the Integrated Disease Surveillance Programme and the Medical Colleges be activated to report on ILI and SARI/pneumonia cases.

The Health officials are also preparing for a situation when the panic created over the increasing number of deaths due to A (H1N1) infection could lead to a mass demand for swine flu tests even for cases of ordinary influenza.

“We are anticipating a situation wherein even those reporting with ordinary fever may demand that they be tested for A (H1N1) flu also. While we cannot deny such demands, it will be a massive strain on our laboratories as well as manpower resources, which might affect our ability to manage actual cases,” a senior Health official said.

The department is planning to increase public awareness about A (H1N1) infection through sustained campaigns and the latest disease updates released by the WHO.

“The public should be more aware and responsible so that there is more voluntary reporting of suspected cases. Despite its ability to spread fast, the virus is still a mild one and can be managed appropriately if people comply with the instructions,” he added.