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Swine flu: how well did India respond?

BMJ 2015; 350 doi: (Published 29 April 2015) Cite this as: BMJ 2015;350:h2286
  1. Jeetha D’Silva, journalist, Mumbai, India
  1. j.dsilva{at}

Some media reports criticised the response, suggesting the recent outbreak of swine flu had led to panic. Jeetha D’Silva reports on India’s increasing preparedness and where more needs to be done to reduce morbidity and mortality

The current outbreak of swine influenza A H1N1 virus sweeping across India is one of the worst flu outbreaks the country has seen in recent years, with over 35 000 people infected1 and 2335 deaths from 1 January to 21 April.2 In the last major outbreak, which followed the global flu pandemic of 2009, India saw 47 840 cases and 2744 deaths during May 2009 to December 2010.3

In the current outbreak, although rapid transmission is a worry, it is the high mortality that has been most alarming. In Jaipur, where the infection broke out in late December, swine flu caused three deaths in the first week of January.4 At the last count, the state had had 429 deaths from swine flu, with 6671 people infected. Rajasthan’s neighbouring state, Gujarat, has had 6561 cases of swine flu since January and a death toll of 439.1

Dinkar Raval, deputy director of epidemics, Gujarat, told The BMJ that the high death rate of 6.63% was “baffling and worrisome.” In comparison, global mortality during the 2009 flu pandemic was 1 in 5000 (0.02% of those infected).5

Improvements over 2009

Despite the high incidence and mortality, health system officials claim that the health ministries at central and state levels have been building competency to deal with influenza outbreaks since the 2009-10 epidemic. Pradip Awate, state surveillance officer for Maharashtra’s integrated disease surveillance programme, told The BMJ, “Between 2009 and now, we have improved our diagnostic facilities and treatment facilities.” Since the previous outbreak, …

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