Sunday, 7 June 2009

Human Influenza A: Hyderabad emerges swine flu capital in India

By Syed Akbar
Hyderabad, June 6: Hyderabad has emerged as the hub of human influenza A virus or swine flu with five of the seven cases reported so far in the country and yet health authorities here have not found it necessary to improve quarantine facilities at the lone nodal centre, the AP Chest Hospital.

A fresh swine flu case was confirmed on Saturday in a four-and-a-half year old girl. She contacted the disease while she was flying down to India from the US from a 20-year-old co-passenger. Her mother is now under surveillance for any swine flu symptoms.

The youth, who passed on the disease to the child, has also transmitted the virus to his brother, who incidentally did not travel outside the country. Both the brothers are now under treatment. This is the first "native" case of swine flu in the country in the sense that the disease has spread locally.

Even as more swine flu cases are adding up in Hyderabad, health authorities continue to make do with the existing facilities, which are not enough to treat severe cases. Luckily, all the cases reported so far in the country are mild and do not require advanced treatment. But the authorities have no answer to the question, what if a severe case of swine flu is admitted to the chest hospital.

Given the severity of the situation and lack of adequate facilities in city hospitals, the National Institute of Communicable Diseases is rushing a team of experts to Hyderabad. It includes a multi-disciplinary rapid response squad.

The World Health Organisation has issued a set of guidelines on treatment of swine flu cases, which include provision of oxygen therapy. The chest hospital does not have such a facility and a senior official admitted that it would acquire one if the need arose. The WHO has also suggested that swabs be taken from more than one source, but health authorities here continue to depend on throat swabs alone.

"All the patients admitted with swine flu are doing well and responding to the treatment. They do not require oxygen therapy. If an emergency arises we will shift the patients to intensive care unit where we have oxygen facility," said Dr K Subhash, coordinator for the State nodal centre for human influenza A. He, however, has no answer when asked if shifting of swine flu patients to intensive care unit will not spread the disease. Those suffering from swine flu have to be in isolation or quarantined.

The WHO guidelines stipulate that samples for laboratory tests should be taken from the deep nasal passages (nasal swab), nasopharynx (naso-pharyngeal swab), throat or, if available, bronchial aspirate. Upper respiratory tract sampling using a combination of a nasal or nasopharyngeal and a throat swab is advised and may
facilitate virus detection. It is not yet known which clinical specimen gives the best diagnostic yield for this specific infection. But for reasons best known to officials, all the samples collected so far are those of throat.

Swine flu is a new influenza virus detected quite recently. This virus spreads from person-to-person, probably in much the same way that regular seasonal influenza (common cold) viruses spread. Human-to-human transmission happens when infected people cough or sneeze. The infected droplets get on their hands, drop onto surfaces, or are dispersed into the air. Another person can breathe in contaminated air, or touch infected hands or surfaces, and be exposed.

To prevent spread, people should cover their mouth and nose with a tissue when coughing, and wash their hands regularly. The early signs of influenza A are flu-like, including fever, cough, headache, muscle and joint pain, sore throat and runny nose, and sometimes vomiting or diarrhoea.

Swine flu has assumed pandemic proportions since thousands of cases have been reported from a vast geographical area. A disease is said to be endemic if it is restricted to a particular area and pandemic when it spreads worldwide.

"At presentation or triage and routinely during subsequent care in hospitalised patients, oxygen saturation should be monitored by pulse oximetry whenever possible. Supplemental oxygen should be provided to correct hypoxaemia (low oxygen content in blood). It is advisable to have an oxygen therapy to maintain oxygen saturation above 90 per cent. Several patients in Mexico have developed ventilator-associated pneumonia or hospital-acquired pneumonia caused by typical nosocomial (hospital) pathogens," a WHO report warns.

According to Dr SV Prasad, superintendent of AP Chest Hospital, the latest swine flu patient, the plus four years girl has been doing well and responding to the treatment. "The girl is playing and her condition is normal," he said.

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