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LLRM Medical College • View topic - India wakes up to Swine Flu.

India wakes up to Swine Flu.

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India wakes up to Swine Flu.

Postby Sadhu » Tue Aug 11, 2009 1:39 am

At long last, India is waking up to the stark reality of the deadly swine flu. And it has taken a mere 6 deaths & about a thousand cases for the reality to sink in that H1N1 A Influenza is here to stay. All the news channels as also the news-papers are swamped with news of swine flu & the most catchy headline seems to be this one :

Chandigarh to Chennai, Gujarat to Guwahati, no area is spared, Swine flu strikes all.

Hope the pandemic subsides soon. Other news reports suggest that a new mutant form may strike millions in a short span of time. God help us all.
Bye for now & GOD Bless.

Rakesh.
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Re: India wakes up to Swine Flu.

Postby Himadri Roy » Tue Aug 11, 2009 4:39 pm

Swine Flu is here to stay for a while in one form or other. It may not be an 'Ebola virus' in terms of mortality rate but it is still going to be a huge burden on financial resources of any country. A big country like India with a huge population is always going to be a target of such epidemics/pandemics. But somehow we Indians are resilient to nearly everything that mother nature throws at us (or is it our attitude ? I am not sure :? ). 'Ram Bharose' we will again some how emerge on top of this 'Bloody Swine' Flu . Jako rakhe sainya Mar sake naa Flu :P
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Re: India wakes up to Swine Flu.

Postby ARVIND MATHUR » Sun Aug 16, 2009 2:57 am

Influenza A H1N1 pandemic...Cause for Concern but surely not for panic :) .
Himadri you are right that despite somewhat indifferent attitude to begin with, Indian institutions are much better prepared to face the challenge and I have no doubts that it would be on top of everything.
Dear Sadhu, you sound pessimistic. Please note that the pandemic is still of moderate severity and case fatality is much lower than any other disease. In fact, we loose a mother every three minutes in child birth and related to pregnancy related complications. However we have accepted this as given truth! More number of deaths today take place due to traffic accidents or tobacco kills more number of people or puts much higher financial burden.
Unfortunately these facts have no new story to tell...like Chandigarh to Chennai.....It is time to be cautious and careful.
In my earlier messages, I have shared simple measures that are needed to protect, prevent spread and there is no rocket science involved. We have effective drug available.
Yes, mutating virus is a cause of worry and I feel scientists are studying the virus behavior very closley including production of vaccine. There is no doubt that we have to be very cautious and I can assure that countries including India are very well prepared and ready to face the challenge. Infact, Indian think tank has been moving promptly and surely.
Media is doing its part but it was only after third/fourth day of senstational news of first death that it brought the facts, preventive messages and Government strategies that can educate common people. It would have been better to brining it on the very first day. Nonetheless, let us hope for the very best and hopefully system would respond in effective and efficient manner.
I shall share more info on HINI once I am back in Pyongyang.
Cheers and ciao
Arvind
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Re: India wakes up to Swine Flu.

Postby Sadhu » Thu Aug 20, 2009 1:01 am

Hi ! Arvind Boss & Himadri Boss.
The reason for my despondency (rather than pessimism) is what you yourself outlined in your letter --- failure in highlighting the prevention & safety measures at the very outset. It is not as if Influenza A H1N1 arrived out of the blue one fine day. There have been media reports of infections & deaths (in other countries) & some feeble attempts at educating people regarding this deadly viral disease for a few months now. A group of students from Jullundar had been to the USA for some school competition & after their return home, all of them developed the disease (though I am not aware of any fatalities in that group). This was around the time some religious leader was shot at in Vienna (was it April or May ?) Still the govt did not awaken from its slumber & did nothing to educate the people about this disease. And now, what have you got ? A panic situation where Delhi Hospitals resemble NASA's laboratories --- what with docs in OPD's in no less than space suits. You really got to see that. It is comic really. And people all over are moving about with masks over their noses, knowing that simple surgical masks are not going to help them prevent the infection, but hoping so nevertheless.
Bye for now & GOD Bless.

Rakesh.
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WHO issues Guidelines -management of patients infected with

Postby ARVIND MATHUR » Fri Aug 21, 2009 10:03 pm

dear all,
These may be useful!
Best wishes
Arvind

Guidelines on management of patients infected with H1N1 Pandemic virus

The guidelines represent the consensus reached by an international panel of experts who reviewed all available studies on the safety and effectiveness of these drugs. Emphasis was placed on the use of oseltamivir and zanamivir to prevent severe illness and deaths, reduce the need for hospitalization, and reduce the duration of hospital stays.

The pandemic virus is currently susceptible to both of these drugs (known as neuraminidase inhibitors), but resistant to a second class of antivirals (the M2 inhibitors).

Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. Healthy patients with uncomplicated illness need not be treated with antivirals.

On an individual patient basis, initial treatment decisions should be based on clinical assessment and knowledge about the presence of the virus in the community.

In areas where the virus is circulating widely in the community, clinicians seeing patients with influenza-like illness should assume that the pandemic virus is the cause. Treatment decisions should not wait for laboratory confirmation of H1N1 infection.

This recommendation is supported by reports, from all outbreak sites, that the H1N1 virus rapidly becomes the dominant strain.

Treat serious cases immediately
Evidence reviewed by the panel indicates that oseltamivir, when properly prescribed, can significantly reduce the risk of pneumonia (a leading cause of death for both pandemic and seasonal influenza) and the need for hospitalization.

For patients who initially present with severe illness or whose condition begins to deteriorate, WHO recommends treatment with oseltamivir as soon as possible. Studies show that early treatment, preferably within 48 hours after symptom onset, is strongly associated with better clinical outcome. For patients with severe or deteriorating illness, treatment should be provided even if started later. Where oseltamivir is unavailable or cannot be used for any reason, zanamivir may be given.

This recommendation applies to all patient groups, including pregnant women, and all age groups, including young children and infants.

For patients with underlying medical conditions that increase the risk of more severe disease, WHO recommends treatment with either oseltamivir or zanamivir. These patients should also receive treatment as soon as possible after symptom onset, without waiting for the results of laboratory tests.

As pregnant women are included among groups at increased risk, WHO recommends that pregnant women receive antiviral treatment as soon as possible after symptom onset.

At the same time, the presence of underlying medical conditions will not reliably predict all or even most cases of severe illness. Worldwide, around 40% of severe cases are now occurring in previously healthy children and adults, usually under the age of 50 years.

Some of these patients experience a sudden and very rapid deterioration in their clinical condition, usually on day 5 or 6 following the onset of symptoms.

Clinical deterioration is characterized by primary viral pneumonia, which destroys the lung tissue and does not respond to antibiotics, and the failure of multiple organs, including the heart, kidneys, and liver. These patients require management in intensive care units using therapies in addition to antivirals.

Clinicians, patients, and those providing home-based care need to be alert to warning signals that indicate progression to a more severe form of illness, and take urgent action, which should include treatment with oseltamivir.

In cases of severe or deteriorating illness, clinicians may consider using higher doses of oseltamivir, and for a longer duration, than is normally prescribed.

Antiviral use in children
Following the recent publication of two clinical reviews, [1,2] some questions have been raised about the advisability of administering antivirals to children.

The two clinical reviews used data that were considered by WHO and its expert panel when developing the current guidelines and are fully reflected in the recommendations.

WHO recommends prompt antiviral treatment for children with severe or deteriorating illness, and those at risk of more severe or complicated illness. This recommendation includes all children under the age of five years, as this age group is at increased risk of more severe illness.

Otherwise healthy children, older than 5 years, need not be given antiviral treatment unless their illness persists or worsens.

Danger signs in all patients
Clinicians, patients, and those providing home-based care need to be alert to danger signs that can signal progression to more severe disease. As progression can be very rapid, medical attention should be sought when any of the following danger signs appear in a person with confirmed or suspected H1N1 infection:

shortness of breath, either during physical activity or while resting
difficulty in breathing
turning blue
bloody or coloured sputum
chest pain
altered mental status
high fever that persists beyond 3 days
low blood pressure.
In children, danger signs include fast or difficult breathing, lack of alertness, difficulty in waking up, and little or no desire to play.
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Re: India wakes up to Swine Flu.

Postby Sadhu » Tue Aug 25, 2009 1:30 am

Very informative piece. Thank you Boss.
Bye for now & GOD Bless.

Rakesh.
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Re: India wakes up to Swine Flu.

Postby ARVIND MATHUR » Wed Sep 16, 2009 6:56 pm

Measures in Schools

WHO issued advice on measures that can be undertaken in schools to reduce the impact of the H1N1 influenza pandemic. Recommendations draw on recent experiences in several countries as well as studies of the health, economic, and social consequences of school closures. These studies were undertaken by members of a WHO informal network for mathematical modelling of the pandemic.

Experience to date has demonstrated the role of schools in amplifying transmission of the pandemic virus, both within schools and into the wider community. While outbreaks in schools are clearly an important dimension of the current pandemic, no single measure can stop or limit transmission in schools, which provide multiple opportunities for spread of the virus.

WHO recommends the use of a range of measures that can be adapted to the local epidemiological situation, available resources, and the social role played by many schools. National and local authorities are in the best position to make decisions about these measures and how they should be adapted and implemented.

WHO continues to recommend that students, teachers, and other staff who feel unwell should stay home. Plans should be in place, and space made available, to isolate students and staff who become ill while at school.

Schools should promote hand hygiene and respiratory etiquette and be stocked with appropriate supplies. Proper cleaning and ventilation and measures to reduce crowding are also advised.

School closures and class suspensions
Decisions about if and when schools should be closed during the pandemic are complex and highly context-specific. WHO cannot provide specific recommendations for or against school closure that are applicable to all settings. However, some general guidance comes from recent experience in several countries in both the northern and southern hemispheres, mathematical modelling, and experience during seasonal epidemics of influenza.

School closure can operate as a proactive measure, aimed at reducing transmission in the school and spread into the wider community. School closure can also be a reactive measure, when schools close or classes are suspended because high levels of absenteeism among students and staff make it impractical to continue classes.

The main health benefit of proactive school closure comes from slowing down the spread of an outbreak within a given area and thus flattening the peak of infections. This benefit becomes especially important when the number of people requiring medical care at the peak of the pandemic threatens to saturate or overwhelm health care capacity. By slowing the speed of spread, school closure can also buy some time as countries intensify preparedness measures or build up supplies of vaccines, antiviral drugs, and other interventions.

The timing of school closure is critically important. Modelling studies suggest that school closure has its greatest benefits when schools are closed very early in an outbreak, ideally before 1% of the population falls ill. Under ideal conditions, school closure can reduce the demand for health care by an estimated 30–50% at the peak of the pandemic. However, if schools close too late in the course of a community-wide outbreak, the resulting reduction in transmission is likely to be very limited.

Policies for school closure need to include measures that limit contact among students when not in school. If students congregate in a setting other than a school, they will continue to spread the virus, and the benefits of school closure will be greatly reduced, if not negated.

Economic and social costs
When making decisions, health officials and school authorities need to be aware of economic and social costs that can be disproportionately high when viewed against these potential benefits.

The main economic cost arises from absenteeism of working parents or guardians who have to stay home to take care of their children. Studies estimate that school closures can lead to the absence of 16% of the workforce, in addition to normal levels of absenteeism and absenteeism due to illness. Such estimates will, however, vary considerably across countries depending on several factors, including the structure of the workforce.

Paradoxically, while school closure can reduce the peak demand on health care systems, it can also disrupt the provision of essential health care, as many doctors and nurses are parents of school-age children.

Decisions also need to consider social welfare issues. Children’s health and well-being can be compromised if highly beneficial school-based social programmes, such as the provision of meals, are interrupted or if young children are left at home without supervision.
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Re: India wakes up to Swine Flu.

Postby ARVIND MATHUR » Wed Sep 16, 2009 6:58 pm

PREPARING FOR THE SECOND WAVE...


Monitoring of outbreaks from different parts of the world provides sufficient information to make some tentative conclusions about how the influenza pandemic might evolve in the coming months.

WHO is advising countries in the northern hemisphere to prepare for a second wave of pandemic spread. Countries with tropical climates, where the pandemic virus arrived later than elsewhere, also need to prepare for an increasing number of cases.

Countries in temperate parts of the southern hemisphere should remain vigilant. As experience has shown, localized “hot spots” of increasing transmission can continue to occur even when the pandemic has peaked at the national level.

H1N1 now the dominant virus strain
Evidence from multiple outbreak sites demonstrates that the H1N1 pandemic virus has rapidly established itself and is now the dominant influenza strain in most parts of the world. The pandemic will persist in the coming months as the virus continues to move through susceptible populations.

Close monitoring of viruses by a WHO network of laboratories shows that viruses from all outbreaks remain virtually identical. Studies have detected no signs that the virus has mutated to a more virulent or lethal form.

Likewise, the clinical picture of pandemic influenza is largely consistent across all countries. The overwhelming majority of patients continue to experience mild illness. Although the virus can cause very severe and fatal illness, also in young and healthy people, the number of such cases remains small.

Large populations susceptible to infection
While these trends are encouraging, large numbers of people in all countries remain susceptible to infection. Even if the current pattern of usually mild illness continues, the impact of the pandemic during the second wave could worsen as larger numbers of people become infected.

Larger numbers of severely ill patients requiring intensive care are likely to be the most urgent burden on health services, creating pressures that could overwhelm intensive care units and possibly disrupt the provision of care for other diseases.

Monitoring for drug resistance
At present, only a handful of pandemic viruses resistant to oseltamivir have been detected worldwide, despite the administration of many millions of treatment courses of antiviral drugs. All of these cases have been extensively investigated, and no instances of onward transmission of drug-resistant virus have been documented to date. Intense monitoring continues, also through the WHO network of laboratories.

Not the same as seasonal influenza
Current evidence points to some important differences between patterns of illness reported during the pandemic and those seen during seasonal epidemics of influenza.

The age groups affected by the pandemic are generally younger. This is true for those most frequently infected, and especially so for those experiencing severe or fatal illness.

To date, most severe cases and deaths have occurred in adults under the age of 50 years, with deaths in the elderly comparatively rare. This age distribution is in stark contrast with seasonal influenza, where around 90% of severe and fatal cases occur in people 65 years of age or older.

Severe respiratory failure
Perhaps most significantly, clinicians from around the world are reporting a very severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections. In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays.

During the winter season in the southern hemisphere, several countries have viewed the need for intensive care as the greatest burden on health services. Some cities in these countries report that nearly 15 percent of hospitalized cases have required intensive care.

Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases.

Vulnerable groups
An increased risk during pregnancy is now consistently well-documented across countries. This risk takes on added significance for a virus, like this one, that preferentially infects younger people.

Data continue to show that certain medical conditions increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression.

When anticipating the impact of the pandemic as more people become infected, health officials need to be aware that many of these predisposing conditions have become much more widespread in recent decades, thus increasing the pool of vulnerable people.

Obesity, which is frequently present in severe and fatal cases, is now a global epidemic. WHO estimates that, worldwide, more than 230 million people suffer from asthma, and more than 220 million people have diabetes.

Moreover, conditions such as asthma and diabetes are not usually considered killer diseases, especially in children and young adults. Young deaths from such conditions, precipitated by infection with the H1N1 virus, can be another dimension of the pandemic’s impact.

Higher risk of hospitalization and death
Several early studies show a higher risk of hospitalization and death among certain subgroups, including minority groups and indigenous populations. In some studies, the risk in these groups is four to five times higher than in the general population.

Although the reasons are not fully understood, possible explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension.

Implications for the developing world
Such findings are likely to have growing relevance as the pandemic gains ground in the developing world, where many millions of people live under deprived conditions and have multiple health problems, with little access to basic health care.

As much current data about the pandemic come from wealthy and middle-income countries, the situation in developing countries will need to be very closely watched. The same virus that causes manageable disruption in affluent countries could have a devastating impact in many parts of the developing world.

Co-infection with HIV
The 2009 influenza pandemic is the first to occur since the emergence of HIV/AIDS. Early data from two countries suggest that people co-infected with H1N1 and HIV are not at increased risk of severe or fatal illness, provided these patients are receiving antiretroviral therapy. In most of these patients, illness caused by H1N1 has been mild, with full recovery.

If these preliminary findings are confirmed, this will be reassuring news for countries where infection with HIV is prevalent and treatment coverage with antiretroviral drugs is good.

On current estimates, around 33 million people are living with HIV/AIDS worldwide. Of these, WHO estimates that around 4 million were receiving antiretroviral therapy at the end of 2008.
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Re: India wakes up to Swine Flu.

Postby Sadhu » Wed Sep 16, 2009 9:01 pm

The epidemic in India seems to be dying down now. More or less, it is limited to a few pockets only, most notably, around Mumbai & Pune and Delhi & the NCR, and the initial media frenzy too seems to have died down. Though deaths are still being reported from swine-flu, there is not so much hype & fright associated with it. I recently visited Delhi for a couple of days, & found no "terror" of H1N1 Influenza A there. Seems we have again fallen into that old mindset --- Chalta Hai. And literally too, life moves on. :P
Bye for now & GOD Bless.

Rakesh.
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Re: India wakes up to Swine Flu.

Postby ARVIND MATHUR » Sun Sep 20, 2009 12:22 am

Sadhu,both the reactions are utterly wrong from managing epidmic point of view. I felt media was sensationalizing bit too much (it always does) and Ministry underplayed initially but then panicked. In a large scale epidemic, one has to be prepared to manage media well and also show full level of preparedness which India always had. However the stage of complacency is not at all desirable even if the initial wave of epidemic is somewhat slow down. This is because the actual 'flu' season now begins. It is around this time that system needs to remain alert and watchful. Hopefully it does. WHO continues to work with member states and recently got committment and donation of few million doses of vaccine which it shall make available to member states per their needs.
Hopefully there is no panick any further, media remains responsible and sensible and ministries prepared to tackle both the epidemic and media.
cheers and ciao
Arvind
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Re: India wakes up to Swine Flu.

Postby Sadhu » Wed Sep 23, 2009 8:21 pm

I beg to differ here. :( I believe, the media, advertently or inadvertently, have succeeded in raising mass awareness about the disease & this has helped a lot in curtailing further spread of the flu. :| Look what happened with HIV. :roll: It quietly kept spreading & we kept living in the false belief that “it can’t happen to us”. Though the initial govt. apathy was deplorable, :evil: the media blitzkrieg has definitely succeeded in doing what the govt. failed to do in the first stage :!:
Bye for now & GOD Bless.

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Re: India wakes up to Swine Flu.

Postby ARVIND MATHUR » Wed Sep 30, 2009 6:15 pm

We can always agree to disagree :roll: !
Media plays an important role as 'Fourth State' to evoke response and action from the system and it does it with different means.
I feel media should play this role more sensibly. Media's interventions were useful but they brought more important items much later in their coverage which resulted in prolonged panick amongst people. Nonetheless, the system is now well prepared and now with Vaccine also available alongside permission of sale of drugs by private pharmacy, i think India is leading from the front. There are lot of lessons to be learnt from this for better prepardeness and responsiveness which I hope are well documented for the scientists and epidemiologists.
We can have a debate or discussions on HIV as it is not media but several other deep seated issues which led to massive spread of the diseases including indifference that you have mentioned.
Cheers and ciao
Arvind
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Re: India wakes up to Swine Flu.

Postby Sadhu » Wed Oct 07, 2009 1:23 am

Well, speaking of debate, why don't we start a thread where we can discuss medical issues, say, one topic every month. We can select the topic by mutual discussion so that each person gets some time to prepare his part. This will be useful to any youngster reading it and may give us a chance to compile some neat little papers as well, what with different people contributing their (specialty) bit :D
Bye for now & GOD Bless.

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Re: India wakes up to Swine Flu.

Postby Himadri Roy » Thu Oct 08, 2009 12:40 am

Excellent idea Sadhu. 'Share your knowledge' section was meant for this purpose only, but somehow that forum never clicked. But we can start anywhere, including in this section. Let us select a topic. All of us have access to internet/pubmed/google scholar etc. Some of us even have online access to many major international journals. We can sub-divide the topic and everybody is welcome to contribute a section.
Before we start a topic, I have the following suggestions:
1) We should preferably discuss topics that cut across several specialities.
2) We may not aim for writing or producing a scientific paper from the resulting discussion. However, if it results in one that would be great. ( :idea: As you said that it might infact result in some good review papers who knows ! :) ) .
3) To avoid copyright infringements we should try to adhere to the guidelines laid down for normal scientific paper writing (i.e to reference the source of information if and when required)
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Re: India wakes up to Swine Flu.

Postby ARVIND MATHUR » Thu Oct 08, 2009 8:12 pm

Dear both,
Good idea but lets use 'Share your knowledge' thread.
I think its fair to have inventory of topics and we can beging with the one that is of interest to most people. Different aspects can be covered fron basic to advanced, clinico-epidemiolgical to costing kind of dimensisons.
Next posting in 'Share your knowledge' thread!
Cheers and ciao
arvind
Dr Arvind Mathur
MD, DHA, DNB
Medical Officer
Family & Community Health
WHO-DPR Korea
Pyongyang
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ARVIND MATHUR
Forum Senior Consultant
 
Posts: 550
Joined: Tue Oct 02, 2007 12:12 am
Location: DPR Korea (1985 Batch)
Occupation: Service
Address: 14, Munsudong
Pyongyang, DPR Korea
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