Expert urges India to sequence swine flu virus; analysis suggests a more virulent virus

[tetano]

With swine flu (H1N1) claiming over 800 lives in India this year, a world-renowned scientist in viral pathogenesis has called for the need to sequencing the circulating strains in the country to find out if the virus is mutated.
Voicing concern over high mortality rate, Rafi Ahmed, director, Emory Vaccine Center in US' Atlanta, has also called for screening the samples for H3N2 and influenza type B besides H1N1 virus.
Talking to reporters here Tuesday, he has also recommended that instead of the current monovalent vaccine which targets only H1N1, India should go for a trivalent vaccine to provide protection from H2N3 and type B as well.

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http://www.business-standard.com/article/news-ians/expert-urges-india-to-sequence-swine-flu-virus-115022401480_1.html

[Pathfinder]

NATIONAL ? ANDHRA PRADESH

HYDERABAD, February 24, 2015
Updated: February 24, 2015 15:41 IST

Sequence H1N1 virus in India: expert


Vaccine Center, Director Emory Vaccine Centre, Atlanta (US) and member of advisory committee for Department of Biotechnology (DBT) Rafi Ahmed on Tuesday said that Indian researchers, especially in government institutions, should, without any delay, ascertain whether the present swine flu virus has mutated or not.

The top scientist said that significant numbers of young adults in Indian States were dying due to H1N1 and it was time Indian researchers started exploring the reasons behind such a phenomenon.

“We saw this happening during Spanish Flu in 1918 when 50 to 100 million people died and young people were a majority. There is an urgent need to sequence the Indian swine flu virus to find whether there is a new strain or the old one. The mortality rate of young people due to H1N1 is worrisome...
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The vaccine specialist, who visited Hyderabad-based Bharat Biotech on Tuesday, cautioned against under-reporting. “I would also advice public health experts and politicians not to under-report cases and deaths.
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http://www.thehindu.com/news/nationa...SS_Syndication

[Pathfinder]

Focus on sequencing of swine flu virus: Immunology expert

Tuesday, 24 February 2015 - 6:45pm IST | Place: Hyderabad | Agency: PTI
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"The first question is: are swine flu infections here due to a strain of virus that's different from other parts of the world. The Indian scientists can do it very quickly by sequencing the virus. That information can be generated within a few weeks," Atlanta's Emory Vaccine Centre Director Dr Rafi Ahmed told reporters.

"It's important to find out why there is an increase in incidence of H1N1 (swine flu) infection in India. The mortality in young children seems to be high. One needs to find out is this a different (virus) strain from the one which is in other parts of the world. That could be an important information. It is very important to get the sequence of the virus to controlling the influenza strain," he said.

"This will be an important information not only for the Indian health officials and scientists to understand what's going on, but also for the world, because if it turns out that a different strain has emerged which has some global implications, the new strain could also spread to other places," Ahmed said.
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http://www.dnaindia.com/health/report-focus-on-sequencing-of-swine-flu-virus-immunology-expert-2063804

[Pathfinder]

H3N2 virus could be behind flu deaths in Telangana: Expert

Prabeerkumar Sikdar,TNN | Feb 25, 2015, 02.59 AM IST
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"Unlike in the United States, tests on swab samples conducted by labs to detect swine flu cases in India do not look for H3N2 virus among suspects," said Dr Rafi, who is also heading ICGEB-Emory Vaccine Centre, Atlanta, US, an inter-governmental programme with New Delhi-based International Centre for Genetic Engineering and Biotechnology (ICGEB), for developing vaccines.

Supporting Ahmed's scientific observation, Dr K Narasimhulu, swine flu coordinator at the state-run Gandhi Hospital, pointed out that he had come across 20 suspicious swine flu deaths this year, but lab test reports concluded they were H1N1 negative.

"Most probably these 20 deaths could have been caused by other strains of swine flu. Though symptoms of these patients have close resemblance to H1N1 infected cases, they succumbed to the disease quickly, i.e. about in three days," said Dr Narasimhulu.
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http://timesofindia.indiatimes.com/c...w/46362772.cms

[tetano]

Amit Sengupta, February 27, 2015

The problem of terming this an epidemic is critically related to the fact that we do not have reliable population wide data regarding disease prevalence and morbidity and mortality related to different diseases. Because we do not have the data we do not know if infection rates and deaths are significantly higher than in ?normal? seasons. It could just be a one season spike in cases, as is to be expected because the immune protection of the 2009 pandemic has receded. Thus for example, if we only go by the number of reported deaths, then it would not be seen as an epidemic in the US ? where an average of 36,000 deaths is related to influenza every year. In India, we simply don?t know the average number of deaths caused by influenza.
However, because we do not have population wide disease surveillance data, many questions remain unanswered. We don?t know if the majority of the flu cases are being caused by the H1N1 virus. We don?t know if the number of cases are significantly higher this season, nor whether a relatively higher percentage of the infected run the risk of severe symptoms. We don?t know if the H1N1 strain has mutated and become more virulent. Because we don?t know, even people at the highest levels of governance are content to speculate and spread disinformation. Recently the Chief Minister of Bengal is believed to have stated that the government would control the swine population in the state to counter the outbreak. Such statements are an example of the ignorance about public health that pervades the highest levels of the administration and government.

,,,

Unfortunately, many patients who are dying could have been saved. They are dying because either the public health system does not have adequate facilities or these facilities are clustered in big cities and hence largely inaccessible to most patients.

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What is frightening about the H1N1 outbreak is not that it is an epidemic which will cause hundreds of thousands of deaths. In all probability it will die down on its own when summer sets in, as all seasonal influenza outbreaks do. What is frightening is that the country?s health system is not in the least prepared to deal with an influenza epidemic, which doesn?t appear to be more severe than most seasonal flu outbreaks. The Government would be happy to dub this as an epidemic, and somehow to then give the idea that it is struggling against odds to provide care under extraordinary circumstances. This is not an extraordinary outbreak, but an extraordinary breakdown of routine public health services.

http://newsclick.in/india/swine-flu-%E2%80%93-extraordinary-breakdown-public-health

[Pathfinder]

March 11, 2015
Updated: March 11, 2015 23:35 IST

Mutations make H1N1 virulent, spread easily

R. PRASAD

The 2014 Indian H1N1 strain has undergone ?important haemagglutinin (HA) mutations? that make it more easily transmissible and virulent in humans, notes a study published today (March 12) in the journal Cell Host and Microbe. The result contradicts the claim made by the Pune-based National Institute of Virology (NIV) that the H1N1 Influenza A strain currently circulating in India has not undergone any mutation and is identical to the 2009 H1N1 pandemic strain.

Three mutations

A set of three amino acid mutations (K166Q, T200A and D225N) in the key flu viral protein called haemagglutinin or HA has been found in the 2014 Indian H1N1 strain.

While the T200A amino acid change improves the ability of the flu virus to bind better to a human lung receptor compared to that of the pandemic H1N1 strain, the D225N mutation has been linked to increased virulence and severity in those infected with H1N1. A previous study has shown that strains that possess the K166Q mutation are less reactive to 2009 H1N1 vaccine-elicited antibodies.
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Except for sequencing the HA and neuraminidase (NA), neither NIV nor any other Indian institution has till date sequenced the whole genome of H1N1 circulating here since last year. Since 2009, India has sequenced the whole genome of only 21 pandemic H1N1 strains (four in 2009, three in 2010, four in 2011, six in 2012 and four in 2013).

Even in the case of HA sequences, India has deposited only two HA sequences last year (in July and August) in the database of the Global Initiative on Sharing All Influenza Data (GISAID) and none this year.

That only two HA sequences have been done and the results deposited in 2014-15 and no whole genome sequencing has been done despite the H1N1 infection spreading to several States, not only reflects the ?poor surveillance? but also ?potentially limits the response to a deadly outbreak.?
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http://www.thehindu.com/sci-tech/health/mutations-make-h1n1-virulent-spread-easily/article6982873.ece

See also:

Influenza Surveillance: 2014?2015 H1N1 ?Swine?-Derived Influenza Viruses from India

https://flutrackers.com/forum/forum/india/seasonal-flu-2009-2014-including-h1n1-pandemic-2009-ai/726591-influenza-surveillance-2014%C2%962015-h1n1-%C2%93swine%C2%94-derived-influenza-viruses-from-india

[Emily]

Published Date: 22 Feb, 2015 (7:45 PM) Gurgaon, Feb 22 (IANS) A section of private doctors in Haryana has accused the state health department of discouraging laboratory tests for swine flu with a view to reducing the burden on government labs and downplay the number of swine flu cases in the state.
The doctors say that without a proper test, diagnosis or treatment of flu patient as H1N1 virus-affected was not only unscientific but also dangerous for the patient.
The state health department recently issued a public advisory and special guidelines to doctors in a meeting with the Indian Medical Association (IMA)...

http://www.mangalorean.com/news.php?...&newsid=551796

[Pathfinder]

Bird Flu Epidemic Update: H1N1 Strains in India May Be Mutating Into More Dangerous Form

Muneeb KaziMar 16, 2015 11:19 AM EDT

A new MIT (Massachusetts Institute of Technology) study had warned that the H1N1 strains in India may have mutated into a more dangerous strain. Acquiring mutation has made the virus more infectious and deadly than the H1N1 strains previously circulated.
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India officials have denied this. They say that the strain is same as the one which circulated in 2009-2010.
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Ram Sasisekharan, one of the research paper's authors said "There is a real need for aggressive surveillance to ensure that the anxiety and hysteria are brought down. When you do real-time surveillance, get organised ... then you can come up with a better strategy to respond to the virus."
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http://www.sciencetimes.com/articles/4272/20150316/bird-flu-epidemic-update-h1n1-strains-in-india-may-be-mutating-into-more-dangerous-form.htm

[Pathfinder]

Deadly outbreak of swine flu in India may be due to a mutated strain

With 1,911 dead, and more than 32,000 affected, why is the Indian government not doing more, doctors ask

March 23, 2015 5:00AM ET
by Zahir Janmohamed @zahirj
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With temperatures rising ? Ahmedabad is expected to hit 107 degrees Fahrenheit this week ? Joshi and his staff are confident that India?s swine-flu problem is on the wane, given that the flu virus thrives in cold temperatures. But MIT researchers Ram Sasisekharan and Kannan Tharakaraman stress the need for caution.
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In a March 11 report based on their analysis of two strains of the virus, the pair observed that it may have mutated into something more distinct, and virulent, than the strain that caused the 2009 outbreak...

Mohamed Baloch, a surgeon in Ahmedabad who used to work at an Indian government-funded hospital, has seen several swine flu patients who were in need of surgery. He says he would not be surprised to hear that the scale of the swine-flu problem is bigger than the Indian government is admitting...
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?Most likely there is probably a new strain that is operational,? says Dr. Om Shrivastav, who runs a swine-flu isolation ward at Jaslok Hospital in Mumbai...
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Samar Halarnkar, the editor of the data-journalism site IndiaSpend, has written a series of articles on swine flu in the country, and adds that the swine-flu samples the researcher duo analyzed came from India?s own National Institute of Virology. ?This report did not come from a roadside clinic. It was published in a peer-reviewed journal published by MIT scientists. If India?s critique is that the MIT scientists should have analyzed more data, then we should ask, ?Why is India not contributing more swine-flu sequences to the public database??? The problem, he says, is that the Indian government becomes prickly when its health practices are criticized. ?Too often in India we close our shutters and become defensive instead of examining what these reports tell us about conditions in our country.?

Gupta disagrees, saying that the government has done what it can to stop the spread of this virus, including working with outsiders. He also firmly rejects the idea that there is underreporting of swine-flu statistics: ?We have it in our interest to prevent this from spreading, and we are handing out masks and information kits each day for free to combat this.?

However, in a hospital across town, another doctor, who asked to remain anonymous for fear of reprisal, says that the government is being lackadaisical in its response. He spent more than 30 years working in an Ahmedabad health department within the central government and now works at an elite private hospital with just 50 beds. He lifts up a stack of files from his desk with one hand, the other covering the patients? names to protect their privacy.

?All these are new swine-flu patients,? he says. ?The summer has already started and we are still seeing cases. It may be less, but it has not gone away. We should just accept that we do not know what is happening.?

Full text:

http://america.aljazeera.com/articles/2015/3/23/deadly-outbreak-of-swine-flu-in-india-may-be-due-to-a-mutated-strain.html