Maharashtra Influenza 2015, 905 fatalities

[tetano]

4 swine flu deaths reported on Wednesday

Nagpur: Deaths of four patients suffering from swine flu were reported by the authorities in the city on Wednesday. Another patient undergoing treatment at Government Medical College and Hospital (GMCH) also passed away on the day. With these deaths, the total number of patients who have succumbed to the disease in this month becomes 13.
The victims whose deaths were recorded by Deputy Directorate of Health Services (DDHS) on Wednesday were a 46-year-old man from Nagpur, a 48-year-old man from Chandrapur, a 32-year-old female from Gondia and a 45-year-old man from Madhya Pradesh. A 30-year-old woman from Seoni, Madhya Pradesh, passed away on Wednesday evening at GMCH, but report of her death is yet to reach the authorities.
"Through the month of November, 25 patients have been admitted in the swine flu ward of GMCH. Eight of them passed away. Presently, there are six patients being treated at the hospital but they are all in stable condition," informed an official from the hospital. Three patients suspected to be H1N1 positive were admitted to the hospital on Wednesday, he added.
Since the beginning of the year, there have been 779 patients suffering from swine flu admitted to various hospitals within Nagpur circle of DDHS. Of them, 176 have succumbed to the disease making the death rate from the disease a little more than 22%. A total of 567 patients have been successfully treated while 36 people are still being treated for it.

http://timesofindia.indiatimes.com/city/nagpur/4-swine-flu-deaths-reported-on-Wednesday/articleshow/49837073.cms

[Ronan Kelly]

Swine flu rears its ugly head again
Umesh Isalkar,TNN | Nov 24, 2015, 05.54 AM IST

PUNE: Sahakarnagar, Hadapsar, Bibvewadi and Tilak Road have emerged as swine flu hotbeds with 400 of the total 743 cases being reported from these areas since the beginning of this year, revealed an area-wise mapping of H1N1 cases.
...
The civic health department analysed the data of the total 1,121 swine flu cases and 148 deaths reported at various hospitals in the city between January and November this year. Of them, 743 patients were local residents while 378 had come to the city from adjoining areas for better medical care. "Among the dead, 49 were local residents while 99 had come to the city from adjoining areas," the report stated.
...
Over 3 lakh people, who were showing influenza-like illness, have been screened in Pune city since January till date. Throat swabs of total 4,080 patients have been tested at government-run as well as designated private laboratories. Among them, throat swabs of 1,122 people have tested positive for swine flu. "Currently, condition of nine people found infected with swine flu is critical. They have been put on ventilator support at different hospitals in the city," Pardeshi said

http://timesofindia.indiatimes.com/city/pune/Swine-flu-rears-its-ugly-head-again/articleshow/49900696.cms

[Ronan Kelly]

PUNE, November 26, 2015
Updated: November 26, 2015 16:34 IST
Maharashtra plans free vaccination drive to combat swine flu

SHOUMOJIT BANERJEE

With the onset of winter and unseasonal bouts of showers last week, the Maharashtra Health Department is determined to combat the recrudescence of the lethal H1N1 virus by introducing free vaccination against swine flu for diabetic and hypertensive persons.

The move is being implemented in a bid to bring down the surging mortality rates that has touched nearly 900 across the State since the beginning of this year.

According to Kanchan Jagtap, State Joint-Director of Health, nearly 400 of the 894 patients who succumbed to swine flu were suffering from diabetes or hypertension.

Nearly 150 deaths have been recorded in Pune city itself, say health authorities, with a woman from Kolhapur succumbing to the virus earlier in the week.

As of now, more than 20,000 women, who are in their second-third trimester of their pregnancy, have been administered dosage across 67 vaccination centres in the State.
...

http://www.thehindu.com/news/national/other-states/maharashtra-plans-free-swine-flu-vaccination/article7919407.ece

[Ronan Kelly]

Free H1N1 vaccine for diabetics, hypertension patients
Sumitra Roy,TNN | Dec 4, 2015, 09.58 PM IST

MUMBAI: The state will be extending the free H1N1 vaccination programme for hypertension and diabetes patients starting next week. Of the 898 people who died of H1N1 in the state this year, 384 (43%) people had at least one of the ailments.

Till now, the free injectable vaccines were available only for healthcare workers and pregnant women. The response from both these groups have been lukewarm. Only 50,000 pregnant women, including 1500 in Mumbai, have agreed to take the vaccine. The seven centres in Mumbai?KEM, Sion, BYL Nair, Kasturba and BMC's maternity homes at Prabhadevi, Oshiwara and Bhandup? that are providing the vaccine to pregnant women, will also be offering it to diabetes and hypertension patients.
...

http://timesofindia.indiatimes.com/city/mumbai/Free-H1N1-vaccine-for-diabetics-hypertension-patients/articleshow/50047154.cms

[Ronan Kelly]

Taken from Quarterly Newsletter from the National Centre for Disease Control (NCDC) Volume 4, Issue 3, July-Sept, 2015
http://nicd.nic.in/writereaddata/lin...5277865388.pdf

Recent Surge of Influenza A H1N1 cases and deaths in India and report of death audit in Maharashtra

The influenza virus is notable for its unique ability to cause recurrent
epidemics and global pandemics. Genetic re-assortments in the influenza virus
cause fast and unpredictable antigenic changes in important immune targets
leading to recurrent epidemics of febrile respiratory disease every 1 to 3 years. In
2009, pandemic Influenza A (H1N1) was the most commonly circulating strain of
influenza virus globally with more than 214 countries reporting laboratory
confirmed cases and over 18,449 deaths reported to WHO as on 1st August 2010.



During current year, India experienced increase in Influenza cases especially Influenza A
H1N1. A total 40,770 cases and 2702 deaths of laboratory confirmed Influenza A H1N1 was
reported (data till 4th Oct 2015).

The rising trend of the cases was observed from the 2nd week of 2015, which continued to
peak till 8th week of 2015 and started to decline during week 18. A total of 35,767 cases &
2218 deaths were reported during the spurt from 2nd week to 18th week. Maximum cases
were reported during the month of February (Fig. 1). The States most affected during the
initial spurt (week 2- week 18) were Rajasthan, Gujarat, Maharashtra, Delhi, Karnataka,
Telangana & Madhya Pradesh.

The cases started increasing again since July 2015 following a decline after the spurt in the
months of Feb ? May 2015. The States of Maharashtra and Kerala were affected initially
with increasing trend of cases & deaths from July. Other states like Gujarat, Karnataka,
Telangana, Madhya Pradesh & Goa have shown a rising trend during the second spurt
(29th week to 39 week) i.e. since August and September 2015 (Fig. 1).

Concerned about the situation the Directorate General of Health Services, Govt. of India
deployed a central teams with the objective to carry out epidemiological investigation to
suggest recommendations for containment in coming season. This report is based on the
key findings of the central team visiting Maharashtra in August to conduct a record based
study of patients admitted in various healthcare institutions to identify risk factors.
In Maharashtra, data was collected from the records available at State Surveillance Unit,
IDSP, Pune, National Institute of Virology, Pune, along with three tertiary care hospitals in
Mumbai and Pune and one diagnostic laboratory centre (Private Laboratory) in Mumbai.
Data was collected from both government and private sector establishments Data was
collected for the recent 50 deaths which includes deaths between periods of 30.7.2015 to
23.9.2015. The team also held discussions with the microbiologist as well as physicians and
programme officers during the visits.

Figure 2 shows the number of cases increasing again since
July 2015 following a decline after the spurt in the months of
Feb ? May 2015 seen across India. Majority of the districts
have reported deaths. It was also observed that Nasik,
Kolhapur, Satara, Sangli were the newer districts reporting
deaths as compared to the last spurt of H1N1 in Maharashtra.



The case fatality rate for the current increase in cases is lower than that witnessed during
preceding months of April, May & June. This shows increasing testing due to awareness
during spurt increased the denominator of positive cases during seasonal spurt.

Maximum deaths were reported from private hospitals (57%) as compared to government
hospitals (43%).

Table 2 shows positivity rates from the various laboratories records. The positivity from the SRL
diagnostic laboratories is nearly 48 % which is higher than the other laboratories.
The team reviewed the death records of recent 50 deaths to identify possible epidemiological
risk factors for mortality.



Age wise distribution of the cases shows maximum proportion of deaths in the age group
of 15-50 yrs age group followed by 30% and 18% among the 50-65yrs & >65yrs age groups
respectively. More young adults were affected compared to older age individuals.

Fifty six percent of deaths were in males as compared to 44% in females. Sixty four percent
of deaths were from urban areas. Symptomatically, fever & cough (60%) was most common
presentation followed by the fever, cough & breathlessness together i.e. (54%) cases.
Maximum deaths were from Mumbai, 15 (30 %), followed by Pune, 7(14%) and Thane, 14
(14%).Fifty nine percent deaths were associated with co- morbidities (n=49). Diabetes (36%)
was the most common co-morbidity observed followed by coronary heart disease (18%),
respiratory diseases (16%), neurological diseases (8%) and obesity (8%) (Figure 3).Out of 50
deaths, 2 (4%) were pregnant women of which one was 36 weeks pregnant while for other
period of gestation was not mentioned. Four (8%) deaths were associated with co infection
which includes dengue, malaria, tuberculosis and leptospirosis each.

Association of co-morbidity and age wise distribution
shows that as age increases the association with the co
morbidity increases (Table 3). Nearly 80 % of death
among the age group more than 50 yrs had an
associated co-morbidity. It was also observed that
nearly 65 % of deaths among the age group 15-50
years had no association with co-morbidity. Comorbidity
appears to increase the risk of mortality among the influenza A H1N1 cases.
Death amongst young adults (without co morbidity) could be due to delayed presentation to
the hospital, transportation delayed or inadequate facility at the treating hospital.



Fifty seven percent of fatal cases had reported to the health facility between 3-7 days of
onset of symptoms while 10 (21.3%) had reported to the health facility after 7 days of onset
of symptoms. Only 5 (10.8%) had started treatment within 48 hrs of onset of symptoms.
21 (42%) & 9 (18%) of deaths occurred within 48 hrs & after 7 days of hospitalization
respectively (Figure 3).

Based on the above findings the team recommended that all patient with diabetes/ co
morbid conditions to be referred to tertiary care centre or specialist as early as possible.
Strict categorization for sample testing specially at private labs needs to be followed as well
as revisiting the private accredited labs for quality testing. Early reporting to health facility
could be improved by increasing awareness among the community as well as health care
worker.

H1N1 hospitals treating such a patient be well equipped
(ventilator management) and train physician in critical care
to initiate early and appropriate treatment.
Initiation of Oseltamivir as earliest after onset of
symptoms so as to decrease the severity of the cases
especially high risk groups as well as halting the
transmission in the community.



Our study reinforces the need to identify and target highrisk
groups for interventions, such as information on
immunization, early medical advice and use of antiviral
medications, as cost of testing is much higher than cost of
vaccination if calculated for each individual as the
positivity reported by Private labs is very high. Further
analytical studies need to be carried out for understanding
the profile of all respiratory viruses causing influenza like illness and severe acute respiratory
infections as well as risk factors between survival and deaths due to influenza A H1N1.

(Contributed by: Drs Prabha Arora, Amol Patil -NCDC, Neeraj Gupta- Safdarjung
Hospital as part of field investigation team; Drs Ranjeet Prasad, Pradeep
Khasnobis as part of H1N1 data analysis team at CSU, IDSP)

[Ronan Kelly]

From Week 46 IDSP Report: http://idsp.nic.in/idsp/IDSP/rcntobrk.pdf

Maharashtra All districts
vii. Seasonal Influenza A(H1N1
8542* 881* 01-01-15 Under
Surveillance
8542 Cases and 881deaths were reported till 46thweek ending on 15th November
2015 from BMC (Brihan Mumbai Mahanagar Corporation), Pune, Nagpur,
Akola Latur, Aurangabad, Nashik, Kolhapur and Thane circles. Majority of cases
and deaths were reported from BMC, Pune and Nagpur circles. State and district
RRTs are continuing the surveillance in the affected areas. All cases are being
treated symptomatically. Health education is being given

14 cases, no fatalities reported in week 46 - Ro

[Ronan Kelly]

This yr, city saw most H1N1 deaths in district
Shrutika Sukhi,TNN | Dec 18, 2015, 01.52 AM IST

THANE: The deadly H1N1 virus has claimed 21 persons from the lake city between January and November, according to reports compiled by the district health officials. Thane city tops in the number of deaths in the district.

Of the 48 patients who succumbed to the swine flu virus in the district in the last 11 months, nearly 50% were from the Thane municipal corporation limits, raising questions about the preventive strategies taken by the civic administration here.
...
As of now, there are no patients admitted due to swine flu in any of the hospitals in the whole district.

http://timesofindia.indiatimes.com/city/thane/This-yr-city-saw-most-H1N1-deaths-in-district/articleshow/50224069.cms

[Ronan Kelly]

Swine flu killed 905 people in Maharashtra in 2015
Priyanka Vora, Hindustan Times, Mumbai | Updated: Jan 02, 2016 00:31 IST

The H1N1 infection killed 905 people in the state in 2015, 35% higher than 2011, when the infection was at its peak.
The state reported 8,583 cases of swine flu in 2015, which means the mortality rate was more than 10%. ?Maharashtra has reported high mortality, but it could be because of a robust surveillance system. We are recording all cases of swine flu in the state,? said Dr Pardeep Awate, in charge of swine flu programme in the state.
...
Mumbai recorded 70 H1N1 deaths last year. Doctors said while the city witnessed a drop in the number of cases in December, Nagpur, Nashik and Pune have reported a higher incidence of cases and deaths in the month.
...

http://www.hindustantimes.com/mumbai/swine-flu-killed-905-people-in-maharashtra-in-2015/story-5gZJYsmCQjUXIzo9eqHNhL.html

Health dept fails to deal with swine flu effectively
Reporters Name | ST Correspondent | Friday, 1 January 2016 AT 11:52 AM ...
nterestingly, rural parts of Pune and Nagpur city were worst hit by H1N1. Health officials claimed that the population is still unexposed to the virus strain and immunity levels are low in these two places.

While Pune rural reported 75 deaths, Pune city and Pimpri-Chinchwad saw 69 and 38 deaths respectively. Nagpur rural and city limits together reported 94 deaths
...

http://www.sakaaltimes.com/NewsDetails.aspx?NewsId=4821611179205591895&SectionId=5171561142064258099&SectionName=Pune&NewsTitle=Health%20dept%20fails%20to%20deal%20with%20swine%20flu%20effectively

[Ronan Kelly]

From Week 50 IDSP Report: http://idsp.nic.in/idsp/IDSP/outbreaks.htm - the editor updated the case & fatality figures, but not those in the text. - Ro

Maharashtra All districts
iv. Seasonal Influenza A(H1N1
8578* cases 900* deaths 01-01-15 Under
Surveillance
8542 Cases and 881deaths were reported till 50th week ending on 13th December
2015 from BMC (Brihan Mumbai Mahanagar Corporation), Pune, Nagpur,
Akola Latur, Aurangabad, Nashik, Kolhapur and Thane circles. Majority of cases
and deaths were reported from BMC, Pune and Nagpur circles. State and district
RRTs are continuing the surveillance in the affected areas. All cases are being
treated symptomatically. Health education is being given.