“Current Affairs Editorial – The Cold Facts – on tracking influenza outbreak”

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              “The Cold Facts – on tracking influenza outbreak”

G.S. Paper II: Issues relating to development and management of Social Sector/Services relating to Health.

What is H1N1:
 Swine influenza is an infection caused by any one of several types of swine influenza viruses.
 It can be any strain of the influenza family of viruses that is endemic in pigs.
 Transmission of the virus from pigs to humans is not common and does not always lead to human flu, often resulting only in the production of antibodies in the blood.
 If transmission does cause human flu, it is called zoonotic swine flu.
 People with regular exposure to pigs are at increased risk of swine flu infection.

Context:
 The influenza virus known as H1N1 or swine flu, landed on Indian shores during the 2009 pandemic, outbreaks.
 Ever since it has been an annual occurrence.
 The worst of Swine flu was in 2015, when 2,990 people succumbed to it.

Active H1N1 Virus and the Increasing Mortality:
 This year the virus has been particularly active.
 The mortality this year at 1,873 is quickly catching up with the 2015 toll.

The Problem with Official Figures:
 In comparison, official figures show 2016 to be a relatively benign year, with an H1N1 death toll of 265.

What the official figures capture:
 The problem with these official figures, however, is that they only capture H1N1 numbers.
 This is a practice that has been adopted in response to the severity of the 2009 pandemic.

Shortcomings of the Prevailing Government Surveillance System:
 And the prevailing practice has many shortcomings.
 The statistics captured by this method hides more than it reveals.

The long presence of influenza in India:
 Influenza was present in India even before 2009 in the form of H3N2 and Influenza B virus types.

The perils of Ignoring H3N2:
 Out of these, H3N2 is capable of causing outbreaks as big as H1N1, and yet India does not track H3N2 cases as extensively as it does H1N1.
 This means that seemingly benign years such as 2016 may probably not be helpful at all because H3N2 and not taking it into account may well be a disaster waiting to happen.
 Data from outside government surveillance systems are making this fact apparent.

Stark realities revealed by other Researches:
 The case in point is a surveillance project for acute febrile illnesses, anchored at the Manipal Centre for Virus Research in Karnataka.

The Effect of Influenza on Rural Areas in India:
 The surveillance project has found that influenza accounts for nearly 20% of fevers across rural areas in 10 Indian States.
 These are those fevers that are often undiagnosed and classified as mystery fevers.

The hidden trends in disease outbreaks:
 During the years when the H1N1 burden is low in these regions, H3N2 and Influenza B circulation tends to spike.

A Huge Underestimation of the Influenza Burden in India:
 All this indicates that India’s surveillance systems are still poor and underestimate the influenza burden substantially.

The Changes in the Viral Genome:
 If numbers are unsatisfactorily tracked, so are changes in the viral genome.
 India submits a woefully small number of H1N1 genetic sequences to global open-access databases.
 For a country of its size and population, India’s contribution to the open access database should have been substantial given the diverse climatic regions the country has and the many possibilities of mutations.

The Importance of Sequencing Data:
 Sequencing is important because it can detect mutations in genetic material that help the virus evade human immune systems, making it more deadly.

India missing out on Mutations:
 Because India does not sequence a large enough sample of viral genomes, it would be missing mutations.
 These mutations could explain changes in the lethality of the virus.

For Sensible Vaccination Decisions:
 Put together, the numbers data and sequence data will enable sensible vaccination decisions.

The Best Weapon against Influenza: Vaccination:
 Vaccination is the best weapon that India has against this menace.
 Because Oseltamivir, the antiviral commonly deployed against flu, is of doubtful efficacy unless administered early enough.

The perils of Staying away from Vaccination:
 Yet, India has thus far stayed away from vaccinating even high-risk groups such as pregnant women and diabetics.

The Way Forward Demands a Change In Perception:
 Because in India, the general perception is that influenza is a more manageable public health challenge compared to mammoths such as tuberculosis.
 Better surveillance of influenza will possibly change this perception by revealing the true scale of this public health issue.