In India this year, 41% of the total number of H1N1 deaths have been reported from Maharashtra. Of the 1,094 deaths from across India, as many as 455 have been from the western State. The State also tops in the number of positive patients — 4,385 cases this year.
So what makes Maharashtra, the epicentre, particularly vulnerable? State health officials point to three main reasons — poor hygiene, overcrowding, and the presence of a good surveillance system to track cases.
‘Cover mouth, nose’
Dr. Satish Pawar, head of the Directorate of Health Services (DHS), Maharashtra, says that the disease has also spread rapidly because the general population fails to follow proper cough-and-sneeze etiquette. “To break the chain of transmission, one has to follow basic manners of using a handkerchief to cover one’s mouth and nose while coughing or sneezing. If not that, one has to at least cover the mouth and nose with the hands and wash them before touching anything anywhere. But this is rarely followed,” he says, adding that posters on preventive steps have been put up in all hospitals and primary health centres.
H1N1 is now endemic and a majority of people infected show extremely mild or no symptoms at all. “For example, if 1,000 people are infected with the virus, 950 will have mild or no symptoms. But these 1,000 people still have the potential to spread the disease,” he says, adding that the challenge becomes greater because of urbanisation and overcrowding.
H1N1, an airborne virus, spreads through airborne droplets from a sick person’s sneeze or cough. Timely treatment and immediate isolation at home is the best way to tackle it, say experts. In Maharashtra this year, 14.15 lakh people were screened of whom 33,789 patients were given Oseltamivir, the drug that works against H1N1.
“Our surveillance system is extremely well developed due to which all cases are recorded thoroughly. A good surveillance system is also a reflection of the increased number of cases that we detect,” says epidemiologist Dr. Pradeep Awate.
Strain combination link
Dr. A.C. Dhariwal, director of the National Centre for Disease Control (NCDC), agrees with Dr. Awate. An antigenic shift, a process in which two or more strains of a virus combine to form a new subtype, is observed at regular intervals which is mainly why there has been a spurt in cases.
“We cannot simply look at the number of deaths. One has to look at the deaths in context with the increasing number of cases,” he says.
Even if it is said to be a seasonal flu, the H1N1 virus is lethal when compared to other seasonal viruses, which explains the high rate of mortality.
“There is no denial that this virus is deadlier than others. But the main reason is that patients and doctors often fail to pick it up on time,” says Mumbai-based infectious disease specialist Dr. Om Shrivastav. Symptoms such as fever, a runny nose and a sore throat are often ignored and self-treated. “By the time patients see a doctor, two or three days have been wasted. For patients with co-morbid conditions, the virus attacks much badly,” he adds.
Immune response
In July, analysis by the civic body in Mumbai supported this trend. It showed that the median time between the onset of symptoms and starting a course of Oseltamivir was 4-5 days. According to Dr. Shrivastav, the spurt in cases could also be because the effect of vaccination had faded. “In 2015, when there were more cases, people got vaccinated. But the vaccine gives immunity for about 8-9 months. This could be the reason why we did not have many cases in 2016 but are now seeing a rise,” he says.
jyoti.s@thehindu.co.in
