Swine flu: What explains sudden spurt in H1N1 human influenza deaths in India

By Syed Akbar
Hyderabad, Aug 10: Scientists and health experts are baffled over the sudden swine flu deaths in the country, even as the National Institute of Virology has clarified that the novel H1N1 virus that causes human influenza has not mutated in India to become more aggressive.

Swine flu has been in existence in the country for the past five months without any fatalities. But in the last one week there have been six deaths, forcing scientists and health experts to think whether the virus had mutated in the country to take a virulent form. Some believe that the novel H1N1 virus is now in the second
phase of manifestation as the human influenza viruses normally do. The Spanish flu virus did the same in early 19th century killing millions of people worldwide.

"We have been monitoring the virus from different human samples. But so far we have not found any mutation or change in the virus. The virus currently present in the country is the same as found in Mexico, USA and other parts of the world," Dr Akhilesh C Mishra, director of NIV, Pune, told this correspondent.

Asked about the sudden swine flu deaths in the last one week, Dr Mishra attributed it to the "wide profiling system" now adopted by health authorities. "Earlier, we used to screen only those coming from other countries. Now we are screening the local public too. This has led to a sudden spurt in the number of cases.
And this explains the deaths too," he clarified.

But senior geneticist Dr M Khaja emphasises the need for a relook at the virus. "All through the history the influenza virus has been mutating. Even the present novel H1N1 virus is a mutant one. There are chances of it mutating further in a country like India with vast population. Swine flu virus is capable of leading to
secondary infection, both viral and bacterial," he said.

Even as local scientists differ on whether the virus has mutated or turned aggressive since temperatures have gone down because of monsoon, American researchers have unravelled the mechanism the human influenza
virus adopts to kill its host.

Swine flu virus is capable of binding deeper into the cells of lungs and stomach, unlike other influenza viruses. "There are slight differences in the way different flu proteins bind to receptors in lungs. Since the swine flu virus binds deeper in the lung's trachea, bronchi and bronchioles, it causes breathing problems,
which ultimately lead to death. The virus is also capable of replicating faster and causing more damage than other influenza viruses. Different patients react differently to the virus. This explains the death of some swine flu patients and survival by others," said US-based senior researcher Dr G R Reddy.

While other influenza virus do not touch the stomach, the novel human influenza virus binds with the stomach lining and intestines. This causes diarrhoea, vomiting and nausea in some patients suffering from swine flu.

Swine flu: A deadly cocktail of Human Influenza A and HIV?

Syed Akbar
Hyderabad, June 17: With swine flu gradually turning deadly in many parts of the world, health experts and scientists fear that a mix of swine flu virus with human immunodeficiency virus (HIV) may lead to a cocktail of a severely potent viral strain that could wreak havoc.

The HIV-H1N1 co-infection risk is more in Andhra Pradesh as it has a large number of people living with HIV. The State has 5.4 lakh HIV positive cases, the highest number for any State in India. Since half of the 31 swine flu cases reported in the country are from Hyderabad and other parts of the State, any lax on the part
of health and quarantine authorities may spell a doom.

Since people with HIV have suppressed immunity, it takes quite a long period for swine flu virus to subside. The virus may develop into a potent viral strain by being a co-pathogen with the human immunodeficiency virus.

"People suffering from HIV, particularly those with low CD4 cell counts in their blood, are at higher risk of contacting swine flu. While swine flu may not develop pneumonia in ordinary people, chances are higher among people living with HIV," warns senior researcher Dr MN Khaja, who formed part of the team that
sequenced Hepatitis C virus.

Moreover, the swine flu or novel influenza A (H1N1) virus may emerge into a more potent viral strain in PLWH as in the case of tuberculosis bacteria. The TB bacteria has turned more potent in people with TB and HIV co-infection, causing resistance to available drugs.

"Though we do not have sufficient research data on H1N1 and HIV co-infection and how severe the human influenza virus would behave in people with low or compromised immunity, the World Health Organisation and the Centers for Disease Control and Prevention, USA, have preliminary data that suggests the severity of the problem. The virus may turn more lethal and a new strain may emerge in HIV hosts," Dr Khaja told this correspondent.

Health officials point out that adults and adolescents with HIV infection are known to be at higher risk for viral and bacterial lower respiratory tract infections and for different types of recurrent pneumonia. Evidence that influenza can be more severe for HIV-infected adults and adolescents comes from studies among HIV-infected persons who had seasonal influenza.

The novel influenza A virus has been found to be sensitive to the neuraminidase inhibitor anti viral medications zanamivir and oseltamivir. But whether it works in people living with HIV is not yet clear.

Epidemic Act: Medical arrests if people do not cooperate

2009
Syed Akbar
Hyderabad, June 13: The fall in temperatures with the onset of rainy season may create a conducive atmosphere for the human influenza virus or swine flu to spread fast through human-to-human contact in the State, even as the State government declared that the Epidemic Act is in force.

Health experts warn that the low temperatures may also aid secondary infection through bacteria, which will make things further complicated. The H1N1 virus does not survive in high temperatures (above 40 degrees C) but the virus may take advantage of the Southwest monsoon to express its potent virulence.

"So far all the cases that have been reported in India are of viral infection, which is not generally life threatening. But the cool weather may aid bacterial infection in swine flu patients. And if this happens, both the virus and the bacteria will create severe health complications, including death," said senior chest physician Dr OA Sarma.

Dr Sarma, who worked as the superintendent of AP Chest Hospital, Hyderabad, told this correspondent that there might be pneumococcal, streptococcal and staphylococcal bacterial infection in swine flu patients. "We have to ensure that there's no secondary infection in these patients," he said.

Meanwhile, the State government has declared that the Epidemic Act of 1897 is already in force in the State and those refusing to cooperate with the authorities may face "medical arrests". The Delhi State government has already announced promulgation of the Act while the Tamil Nadu government had threatened to implement the British Era legislation.

"We have been regularly enforcing the Epidemic Act to act against traders, hoteliers etc who refuse to comply with hygienic conditions. So far there have been no cases of resistance from swine flu patients or suspects. If anyone refuses medical treatment or quarantine we will act under the Epidemic Act," said Principal Secretary (health) Dr LV Subrahmanyam.

The Union Civil Aviation Ministry has agreed in principal to install thermal scanners at international airports to separate out swine flu patients. The scanners detect the body temperature and those with abnormal body temperature (above 98.4 degrees F) will be medically examined for swine flu symptoms.

The country's first thermal scanners will be operational in Mumbai in a day or two. With half of the swine flu cases reported in the country being from Hyderabad, the city airport will also get thermal scanners. "There's
a proposal with the Union Civil Aviation Ministry," an official of GMR airport said.

Little known hepatitis E virus spreads jaundice in Hyderabad

2007
By Syed Akbar
Hyderabad, Dec 27: A little known hepatitis E virus is responsible for spread of viral hepatitis (jaundice) in Hyderabad.
The viral hepatitis, caused by hepatitis E virus, remains mostly undiagnosed for the simple reason that doctors go in for serum tests for more famous cousins of HEV, the hepatitis A and hepatitis B viruses. Tests for hepatitis A and B viruses do not reveal the presence of HEV and the patient silently suffers till the immunity builds up or some health expert chances upon the HEV test.
A study conducted by P Sarguna, A Rao and KN Sudha Ramana of the city-based Sir Ronald Ross Institute of Tropical and Communicable Diseases (Fever Hospital), during a recent waterborne outbreak of viral hepatitis in old city, revealed that 78.57 per cent of the cases related to hepatitis E while 5.31 per cent of the cases were because of mixed infection caused by HEV and HAV.
As many as 546 clinically and biochemically documented cases were screened for the hepatotropic viral markers, hepatitis A, B, C, and E by ELISA method. The study revealed that HEV was the major etiological agent transmitted by contaminated drinking water. The researchers highlighted the importance of screening for both enterically (oral route) transmitted hepatotropic viral markers as well as the parenterally (other than oral route) transmitted hepatotropic viral markers during outbreaks of acute viral hepatitis in Hyderabad and elsewhere in the State.
Since the development of jaundice is a characteristic feature of liver disease (in all hepatitis viral strains), a correct diagnosis can only be made by testing the serum of patient for the presence of specific viral antigens.
Hepatitis E infection was hitherto considered to be present only in Central and South-East Asia, North and West Africa, and in Mexico, although serological surveys suggest a global distribution of strains of hepatitis E of low pathogenicity. Hyderabad generally has cases of hepatitis A, B and C and now the E strain of the hepatitis virus has made its presence felt in this part of the world.
"Hepatitis E should be suspected in outbreaks of waterborne hepatitis occurring in developing countries, especially if the disease is more severe in pregnant women, or if hepatitis A has been excluded. If laboratory tests are not available, epidemiological evidence can help in establishing a diagnosis," the WHO says in its latest guidelines. The city study on HEV gains significance in the backdrop of these WHO suggestions.