India draws up emergency plan to tackle H1N1 outbreak

BMJ 2013; 346 doi: (Published 22 February 2013) Cite this as: BMJ 2013;346:f1198
  1. Mohuya Chaudhuri
  1. 1New Delhi

The Indian government has been forced to draft an emergency plan to tackle an escalating outbreak of H1N1 influenza, because it does not have a plan in place to deal with recurring outbreaks of the infection.

Between 1 January and mid-February 872 cases of H1N1 flu were officially reported, including 145 deaths. But senior officials at the Ministry of Health and Family Welfare who are monitoring the outbreak have said that the actual numbers are much higher, because not all cases are reported, especially where patients have mild infection.

The government will send rapid response teams to seriously affected states such as Rajasthan, where around 500 cases and 111 deaths have been recorded in the past 40 days.

Neeraj Jain, head of the department of respiratory medicine at Sri Gangaram Hospital in New Delhi, said, “There has been a surge in H1N1 flu cases this year, and many of them have been severe, needing critical care. Four patients have died [here] in the last month alone.”

He said that a disturbing number of patients who were not immunocompromised and had no coinfections or serious coexisting conditions were deteriorating rapidly and dying. The National Institute of Virology, in Pune, Maharashtra, is examining the virus to see whether there has been a significant mutation that might be responsible for the marked virulence. Antigenic drift occurs often with flu viruses, but so far virologists have said that mutations in H1N1 have been minor.

Randeep Guleria, professor of medicine at the All India Institute of Medical Sciences, New Delhi, said that during the 2009 H1N1 pandemic there had also been under-reporting, and he criticised the lack of a government strategy to deal with regular outbreaks of flu.

During the 2009 pandemic the government had promised to put in place a robust surveillance system to track flu cases, but this has not happened. As a result, the disease burden is hard to ascertain, making it difficult to plan interventions.

A year after the pandemic, awareness campaigns on flu prevention, including hand washing, sanitation, vaccination, and screening of children in schools, were stopped.

Currently India has stocks of oseltamivir for treating patients with H1N1 flu, said the health ministry’s Emergency Medical Relief section, but if there are repeated outbreaks this stock would be insufficient and a vaccination programme would be needed, team officials acknowledged.


Cite this as: BMJ 2013;346:f1198