The parents of 18-month-old Rakib are still reeling under the shock of losing their son to swine flu on April 28. What started as fever and vomiting got worse with time, and his family soon had to admit him to a private hospital in Mumbai. But when there was no improvement in his condition, they shifted him to another hospital where he was directly admitted to the ICU. “However, we were unhappy with the treatment being provided and then got him admitted to the civic-run Kasturba hospital,” says Tanveer Ansari, Rakib’s father.
Three days after being admitted to the hospital, where he tested positive for swine flu and had to be put on ventilator support, Rakib succumbed to the influenza virus that causes H1N1 or swine flu. “The doctors at Kasturba hospital tried their best to save my son and we were satisfied with the treatment he received. But unfortunately, he could not be saved,” says Nuzad, the mother.
According to Brihanmumbai Municipal Corporation (BMC) authorities, this was the first swine flu death in Mumbai in the last two years. But the numbers are higher in other parts of Maharashtra. Since this January, 844 patients have tested positive for H1N1 and 165 deaths have been reported so far, says Dr Pradeep Awate, state survey epidemics officer. Most of these patients are from Pune, Nashik, Aurangabad and Ahmednagar. Mumbai, on the other hand, had 18 cases in the last two months, according to BMC’s epidemiologist Dr Mini Khetrapal.
The large number of swine flu cases in western Maharashtra may be due to the uneven temperatures between daytime and nighttime. The fluctuations in temperature help in viral growth, says Awate. “There are far fewer cases of swine flu in other parts of the state like Vidarbha and the Marathwada belt,” he says. Also, most patients who succumbed to swine flu suffered from co-morbidities like diabetes and hypertension. “We are now mainly focusing on giving vaccines to patients with co-morbidities, including health care workers and pregnant women, who are more vulnerable to the virus,” says Awate.
After Maharashtra, Telangana has the highest number of swine flu deaths—22. According to the Telangana government, 1,446 patients have tested positive for swine flu this year. Across the country, more than 5,000 people have the airborne disease.
Apart from co-morbidities, patients who test positive for swine flu seem to have spent time in overcrowded places at weddings and social gatherings, says Dr Sudhir Prasad, senior consultant pulmonologist at Aware Gleneagles Global Hospitals, Hyderabad. “These events are where the influenza A virus spreads. It is important for patients to be treated within 48 hours after displaying symptoms of swine flu,” he says. There has been an increase in number of patients with suspected viral pneumonia, too, in the last few weeks, says Prasad. “In our outpatient department, patients mainly with a history of travel have suspected viral pneumonia and around 15 per cent of them test positive for swine flu,” he says.
What has baffled doctors is the outbreak of swine flu in the midst of a sweltering summer instead of the usual winter. According to Awate, it is mainly attributed to a new strain of the influenza A virus. Scientists at the National Institute of Virology (NIV) and the Indian Council of Medical Research (ICMR) declared that they had isolated a new strain, known as the Michigan strain during an ongoing H1N1 surveillance across the country. “The World Health Organization also found that the virus strain has changed from the California strain to Michigan due to which the vaccines had to be changed in the southern hemisphere. The fact is that the characteristics of the virus keep changing every two years or so. However, the good news is the new strain is sensitive to the drugs being used to treat swine flu,” explains Awate. “Whenever there is a new virus strain, the body has no immunity against it and that is why it spreads like forest fire.” Dr Devendra Mourya, director of NIV, and Dr Sanjay Mehendale, additional director general, ICMR were unavailable for comment.
Prasad says there is, without a doubt, a shift and drift in the swine flu virus. “And, some patients are also resistant to antiviral medicines. This year, doctors are now going to use tetravalent vaccines instead of trivalent vaccines [traditional flu vaccines that don’t contain influenza virus] which were being used earlier. The new vaccine will give better results,” he says.
However, not all doctors are convinced that the Michigan strain is the reason behind the rapid increase in the number of swine flu cases. “It is true viral infections go through an antigenic shift from time to time,” says Dr Om Shrivastav, who specialises in infectious diseases and immunology. “This means the virus changes through some kind of movement or shift every two years and this is relevant for viruses other than influenza A. However, at best, the Michigan strain is a scientific speculation and nothing else. It can be proven only when the researchers are able to show an antigenic shift and where the samples were collected from.”
Dr K. Manohar, nodal officer for swine flu in Telangana and director of Nizam’s Institute of Medical Sciences, says, “The observations of a Michigan strain made by other countries have not been established so far. To determine whether there is a new strain of the H1N1 virus, a gene sequencing test needs to be done, which takes a period of at least 28 days.”
