Swine flu grips northern and western India

BMJ 2013; 346 doi: (Published 19 March 2013) Cite this as: BMJ 2013;346:f1802
  1. Soumyadeep Bhaumik
  1. 1Kolkata

The Indian government, which in mid-February rolled out an emergency plan to tackle the outbreak of H1N1 influenza,1 now seems to be struggling to contain the disease.

In spite of preventive measures and the presence of rapid response teams in various states, the H1N1 virus continues to spread unabated in northern and western India and is currently affecting thousands of people in Delhi, Gujarat, Rajasthan, and Haryana.

The latest figures released through the Press Information Bureau by the Ministry of Health and Family Welfare show that nationally between 1 January and 24 February a total of 2267 cases of swine flu were confirmed by laboratory testing and that 254 people had died from the disease.2

Delhi had the most cases (759), while Rajasthan had a particularly high death rate, as that state had the highest number of deaths (105) to 24 February, despite having a lower incidence of swine flu than Delhi.

The outbreak seems to be getting worse, with new cases being reported every day. Delhi has now reported 1351 cases and 18 deaths.

Dinkar Raval, deputy director (epidemic) and the nodal officer of swine flu in Gujarat, told the BMJ that up to 15 March his state had seen 533 cases and 105 deaths in the current outbreak. However, by 18 March the death toll in Gujarat had risen to 118, with the number of cases increasing to 633. The death toll is the second highest in the country, after Rajasthan, where the epidemic has killed 130 people.

In Gujarat a high proportion of cases and deaths have been reported from the cities of Rajkot and Jamnagar, and among the deaths in the state women made up a disproportionate number. The Gujarat Assembly witnessed turmoil over the issue of swine flu, with opposition leaders demanding an adjournment.

The mortality rate is higher in the current outbreak than that in 2009. Although scientists at Pune’s National Institute of Virology have seen genetic mutations in the samples of the H1N1 virus, particularly at the D97N and K283 amino acid positions of the virus’s haemagglutinin gene, these were not thought to be the cause of the high mortality.

Raval told the media that “the government has enough stock of Tamiflu in various dispensaries and in various medical store outlets.”3

However, given doubts about the safety and efficacy of Tamiflu arising from the lack of availability of clinical trial data, as highlighted in the BMJ’s open data campaign ( doctors are sceptical about using the drug.

Because patients were dying it was now important “to remove doubts from physicians about the drug by making available to them data which have been hidden,” a clinician from Delhi, who wished to remain anonymous, told the BMJ.


Cite this as: BMJ 2013;346:f1802