CHENNAI: Why this panic over pandemic flu? The pandemic is long over; it was declared on 11 June 2009 – and declared ended on 10 August 2010.Like in the past, the new virus strain continues to circulate and is qualified “seasonal” (in cold countries) and “endemic” in warm countries. The virus is no longer swine flu, but human influenza virus A/pandemic 2009/H1N1, which is endemic in India. It is no surprise that it is found when specifically looked for, but it will be found only where it is looked for. The pre-pandemic endemic virus A/ H3N2 also continues to circulate.After the 1918, 1957 and 1968 pandemics, the pre-pandemic strains were abruptly and completely replaced by the new pandemic strain. But not this time – so, both H3N2 and H1N1 pandemic strains are cocirculating globally. There was a non-pandemic H1N1 circulating in some countries, on a low key, but that virus seems to have disappeared, replaced by pandemic H1N1.Post-pandemic, our healthcare workers have access to diagnostic tests, and are surprised and even scared when they detect H1N1. The pandemic scare is fresh in the mind, so people panic, not realising that it is an everyday occurrence.If tested for, you will find flu B virus in some cases. If you test for H3N2, you will find that in some. So, if systematically investigated, a proportion of influenza-like illness (ILI) will turn out to be positive for any one of these 3 viruses. Mirror, mirror, among people which is the most contagious and most severe? Flu B is mostly mild, but in adults it can be quite severe. Flu A, irrespective of which strain, is also mostly without symptoms or mild, but occasionally severe, even fatal if complications set in.In short, diagnosis and treatment of respiratory distress and bacterial supra-infection are the same for all strains.Everywhere flu is known to kill – particularly the very young and the very old.H1N1 is no exception, but there is an additional vulnerability factor – pregnancy.So, any pregnant woman with ILI must be quickly tested for flu A and in case H1 is detected, immediately treated with Oseltamivir – which is available in the government healthcare system, thanks to the pandemic. The current flu vaccine contains antigens from all three H1N1, H3N2 and B.In India, lab diagnosis is mostly applied for crisis management - not for routine diagnosis and protocolbased treatment. Healthcare workers often shoot in the dark, without accurate diagnosis for those hospitalised with any suspected infection.What India needs is more access to lab tests for all infectious diseases, to guide cause-specific treatment – not shot-gun at once covering several microbes.That has led to serious threats from antibiotic resistance.As for flu, the bird flu H5N1 is one that should not be missed from diagnosis – it spreads fast among chickens and if detected, they should be culled to contain infection. Occasionally humans get infected; death rate is the highest for H5N1.In many countries, an H5N1 outbreak in poultry comes to light only when a human is found infected; poultry death tends to be hidden.Wherever human are in contact with birds, flu tests must include H5.India needs continuous, real-time surveillance of reportable diseases. Law exists covering over 20 diseases, but reporting is not enforced for lack of will, knowledge and public health infrastructure.At least Tamil Nadu has a Department of Public Health with Deputy Directors of Public Health covering all districts - something unique in India. However, even here disease surveillance has not been given due importance because of weaknesses in staff strength. If this deficiency is covered and access to laboratories ensured, Tamil Nadu could lead the country in disease prevention and outbreak control on modern scientific lines.(The author is a vaccine expert and Professor Emeritus of Virology at CMC)
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