Avian Flu Diary: Indian Expert: `Nothing Scary About Outbreak?

[Ronan Kelly]

MONDAY, APRIL 09, 2012
Indian Expert: `Nothing Scary About Outbreak?
# 6268

For several weeks newspaper headlines in India have been warning about the spread and rising death toll from the H1N1 `Swine flu? virus. This story has been covered with the kind of exuberance typical of the Indian Press; a few headlines from this past weekend serve to illustrate the point:



Swine flu cases spark alarm in Vizag The New Indian Express
Swine flu redux: is this a mutated summer strain?-First Post.India

Swine flu panic goes viral in Chennai The New Indian Express
Tamil Nadu sitting on swine flu tinderbox The Asian Age
Fear of H1N1 outbreak puts Kerala on alert Gulf News
Officials try to hush up flu toll Deccan Herald
DMO cautions against spread of H1N1 The New Indian Express



To spare you from having to read all of these reports, they contain rumors of government cover ups, stories of crowded clinics, a mounting death toll interspersed with almost obligatory speculation over the possibility that some (as yet unidentified) `mutation? in the H1N1 virus has revived its ferocity.

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http://afludiary.blogspot.fr/2012/04/indian-expert-nothing-scary-about.html

[Ronan Kelly]

Re: Avian Flu Diary: Indian Expert: `Nothing Scary About Outbreak?

H1N1 cases in India sparking media hype

Lisa Schnirring Staff Writer
Apr 9, 2012 (CIDRAP News) ? Reports of sporadic 2009 H1N1 infections and a few deaths in parts of India have sparked high-profile media coverage of the disease in the country, catching the attention of public health officials and vaccine makers, according to several media reports.

Global health monitoring has not suggested an unusual spike in flu activity in India. The most recent report for India in the World Health Organization (WHO) Global Influenza Surveillance and Response System (GISRS) shows a modest rise in flu activity over the past few weeks, with the 2009 H1N1 virus edging out influenza B as the dominant strain during epidemiologic week 11, which ended the third week of March.

Concerns over a rising number of 2009 H1N1 cases in India have prompted three Indian vaccine makers to resume production of the monovalent vaccine, according to an Apr 7 report in The Economic Times, an English language daily financial newspaper based in Mumbai. It said Zydus Cadila, Panacea Biotech, and Serum Institute are projecting an increase in demand, because over the past 3 months about 281 people have tested positive for the virus, and 21 deaths have been reported.

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http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/apr0912swine-br.html

[Ronan Kelly]

Re: Avian Flu Diary: Indian Expert: `Nothing Scary About Outbreak?

Unfortunately the GISRS data quoted in the above report is over three weeks old and should not really be used to comment on current levels of flu. The situation in India is always somewhat more murky than official figures suggest.

For example Nair et al suggested that approximately 26,000 Indian children under the age of 5 die from pneumonia caused by influenza each year. But we do not see any test results supporting this because in the vast majority of cases testing is never done. Approximately 50% of the fatalities never even make it to a hospital.

In the US, the number of children confirmed killed by H1N1 during the pandemic was 3 to 4 times greater than the average of the previous few years. Given a similar multiplier in India, 75-100,000 children under age 5 may have died in the 2009-2010 pandemic. In contrast, media and government sources reported 278 confirmed fatalities of individuals under 20 with H1N1 from August 2009 to October 2010. This is an undercount of at least 100 to 1 and perhaps by as much as 500 or more to 1.

Given that we have documented evidence that confirmed fatalities in India are a significant undercount of actual fatalities, it is less trivial to dismiss the current outbreak. There are 46 confirmed H1N1 fatalities since March 1st. How many is that really? 46, 4,600 or 23,000?

India has such a large population that even the largest figure represents an increase above expected mortality of only 1-2% and is easily missed especially when mortality rates are not closely monitored anyway.

[Ronan Kelly]

Re: Avian Flu Diary: Indian Expert: `Nothing Scary About Outbreak?

Updated GISRS data; http://gamapserver.who.int/gareports...spx?ReportNo=1

[Ronan Kelly]

Re: Avian Flu Diary: Indian Expert: `Nothing Scary About Outbreak?

Swine flu far from lethal than India thought, study shows
Kounteya Sinha, TNN | Jun 26, 2012, 08.43AM IST
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The scientists say, "China and India, where about a third of the world's population live have garnered little information about the burden of influenza."

India's age-adjusted respiratory and cardiovascular mortality rate associated with 2009 pandemic influenza H1N1 per 100 000 individuals stood at 4.1-6 per 100,000 population. Lead author Dr Fatimah S Dawood from the CDC said, "The study underscores the significant human toll of an influenza pandemic. We hope that this work can be used not only to improve influenza disease burden modeling globally, but to improve the public health response during future pandemics in parts of the world that suffer more deaths and to increase the public's awareness of the importance of influenza prevention".

It said, "As a general rule, the number of lab-confirmed flu deaths is known to be significantly lower than the number of flu deaths that actually occur, and the new research indicates that an estimated 151,700 to 575,400 people died as a result of having contracted 2009 H1N1 during the first year that the virus circulated in each country worldwide."

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http://timesofindia.indiatimes.com/india/Swine-flu-far-from-lethal-than-India-thought-study-shows/articleshow/14402415.cms

For India with a population of 1.2 billion, a mortality rate of 4.1 - 6 per 100,000 population gives fatality estimates of 49,200 to 72,000 individuals. In contrast, from July 2009 to June 2010 only 1,584 fatal cases were lab confirmed. - Ro

http://pib.nic.in/newsite/erelease.aspx?relid=62858