Sri Lanka - 5 deaths confirmed from H1N1 - Tamiflu Needed

[drjagathv]

Re: Sri Lanka H1N1 cases - 110

Re: Sri Lanka H1N1 cases - 110

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Condition of all patients suffering with H1N1 infection is not life threatening is no longer true.
First suspected death of a child due to influenza A-H1N1 belong to a high risk group seem have occurred in the outstations of Sri Lanka. Still it is not confirmed, however, it is unfortunate that tests are not readily available for the patients suspected to be suffering with H1N1 infections in Kandy. Health officials warned that due to unnecessary closure of roads air is polluted and children are at high risk of getting severe respiratory illnesses in Kandy. It takes several days to send the samples and obtain results from Colombo whenever the medical profession encounter suspected patients with H1N1 infections. Antiviral drugs such as oseltamivir phosphate are not available for the medical practitioners to promptly obtain from the pharmacies on prescription. To obtain oseltamivir phosphate it needs special permission from the Colombo officials, which could lead to unnecessary delay in initiating early treatment. Early treatment can prevent death in H1N1 where as late treatment would not be very effective. Even the medical profession and consultants in outstations cannot obtain oseltamivir due these restrictions. It is time to correct these errors and try and save valuable lives of other children who are at risk of loosing lives due to H1N1 infections in Kandy.

 

[drjagathv]

Re: Sri Lanka H1N1 cases - 110

Re: Sri Lanka H1N1 cases - 110

--------------------------------------------------------------------------------

Recommendations for the high risk groups about the H1N1 virus Focus on protecting those at highest risk. http://www.flutrackers.com/forum/showthread.php?t=124224


It is important to highlight if there are any short comings and adopt corrective measures to rectify them without any further delay, which would help saving many valuable lives in the near future. That is the social responsibility of all citizens living in this planet. If we do not highlight them, then we have not done our duties on behalf of our patients. Their voice is not heard at all. If we can save few more lives, at the end of the day we have then done our service for the mankind. That is our social responsibility. We thank flu-Trackers regarding your commitment.
Dr. V W Jagath Vasanthathilaka.
Consultant Rheumatologist.

 

[drjagathv]

Re: Sri Lanka H1N1 cases - 110

Re: Sri Lanka H1N1 cases - 110

--------------------------------------------------------------------------------

Recommendations for the high risk groups about the H1N1 virus Focus on protecting those at highest risk. http://www.flutrackers.com/forum/showthread.php?t=124224


It is important to highlight if there are any short comings and adopt corrective measures to rectify them without any further delay, which would help saving many valuable lives in the near future. That is the social responsibility of all citizens living in this planet. If we do not highlight them, then we have not done our duties on behalf of our patients. Their voice is not heard at all. If we can save few more lives, at the end of the day we have then done our service for the mankind. That is our social responsibility. We thank flu-Trackers regarding your commitment.
Dr. V W Jagath Vasanthathilaka.
Consultant Rheumatologist.

Health authorities in Sri Lanka are taking further measures to face the new situation. They are aware of the current situation and they consider relaxing some of the restrictions on issue of drugs. Health authorities are also taking steps to make sure tests are readily available in the outstations. It is also the responsibly of the consultants and clinicians to advice the health authorities on appropriate strategies to face a new situation.

 

[sharon sanders]

Re: Sri Lanka H1N1 cases - 110

Re: Sri Lanka H1N1 cases - 110

Population of Sri Lanka is approx. 20 million- only enough tamiflu for 30,000


Nov 07, Colombo:

First suspected death due to influenza A-H1N1 of a child in Kandy who belonged to a high risk group is most probably due to the pneumonia related to the flu, health sources said.


The recent death of the child, whose parents were medical professionals, was sending the message that condition of all the patients contracting H1N1 flu may not be life threatening is no longer true.


The cause of the child's death whether it was due to H1N1 was still not confirmed. Samples have been sent to the Medical Research Council in Colombo for verification of the presence of H1N1 virus. A full inquiry is being held into the death to ascertain the cause.


According to a health professional speaking on anonymity, tests are not readily available in Kandy for the patients suspected to be suffering with H1N1 infections. It takes several days to send the samples and obtain results from Colombo whenever the medical professionals encounter suspected patients with H1N1 infections.



The health professional said the antiviral drugs such as oseltamivir (Tamiflu) are not available for the medical practitioners to promptly obtain from the pharmacies on prescription. The doctors in outstations need special permission from the Colombo officials to obtain oseltamivir, which could lead to unnecessary delay in initiating early treatment.


It is time to correct these errors to try and save valuable lives of other children who may be at risk due to H1N1 infections in areas outside Colombo, the source added.


Oseltamivir must be taken within 12 to 48 hours from the first appearance of flu symptoms to stop the flu virus from spreading inside the body. However, the drug does not prevent secondary complications arising from the flu.


The Health Ministry has imported stocks of oseltamivir sufficient for the treatment of 30,000 individuals but specified that the treatment would only be given to those severely in need of it.


The Epidemiology Unit of the Health Ministry has set up sentinel units in twenty hospitals around the country with specially trained personnel to treat persons found to be positive with H1N1.


According to the guidelines of the Epidemiology Unit only patients with severe or progressive symptoms will be admitted to hospitals for laboratory diagnosis and treatment with anti virals. Those with mild illness would be managed as out patients with supportive medication and proper advice.


The anti viral agent oseltamivir has been available only in sentinel hospitals and the sentinel sites have been urged make arrangements to get their stocks through the Medical Supplies Division. Peradeniya Teaching Hospital is the nearest sentinel site to the city of Kandy.


http://www.colombopage.com/archive_091/Nov1257534810CH.html

 

[drjagathv]

Re: Sri Lanka H1N1 cases - 110

Re: Sri Lanka H1N1 cases - 110

Health authorities in Sri Lanka are taking further measures to face the new situation. They are aware of the current situation and they consider relaxing some of the restrictions on issue of drugs. Health authorities are also taking steps to make sure tests are readily available in the outstations. It is also the responsibly of the consultants and clinicians to advice the health authorities on appropriate strategies to face a new situation.

Early treatment as well as appropriate preventive measures taken by the health care professionals would help us prevent further complications related to H1N1 infections. Clinicians and the consultants who attend suspected patients with H1N1 in Sri Lanka suggest that introduction and wide spread availability H1N1 vaccine at this stage would minimize further dissemination of H1N1 infections in the outstations as well as in the Capital.

Dr. V W Jagath Vasanthathilaka.

 

[Roehl_JC]

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

First Swine flu death in Lanka

By Kumudini Hettiarachchi
A 16-year-old boy in Kandy has died of H1N1 (Swine flu), the first reported death in Sri Lanka of this global pandemic flu, senior health officials confirmed yesterday.

The victim, son of two doctors, died on Wednesday night at the Kandy Teaching Hospital, the officials said. The Medical Research Institute confirmed that the death was caused by H1N1, the officials who declined to be identified, said.
Officials stressed, however, that there was no cause for alarm and urged the public not to panic. ?This boy had other complications including spinal and lung problems which could have aggravated the illness and placed him in a high-risk category,? one official explained.

They advised the public to go to the nearest hospital if anyone has a persistent fever for more than two days and flu-like symptoms as most state hospitals are geared to handle H1N1, while Base Hospitals which have consultants have been issued with anti-viral drugs to deal with the virus, an official said. The anti-virals should be taken only on the recommendation of a consultant who has clinically diagnosed H1N1 and deems it the right time to administer them, he said.

Although earlier H1N1 was diagnosed among those coming from abroad and their close contacts, the ?community spread? of this flu has now begun in the country. Up to October 15, 115 H1N1-affected people had been detected through the airport surveillance mechanism.

Factbox: H1N1 is a new influenza virus which started spreading in Mexico in April this year. It is like any other flu, and the symptoms include fever, cough, sore throat, muscle aches, headache, chills, fatigue and sometimes diarrhoea and vomiting.




http://www.sundaytimes.lk/091108/News/nws_04.html

 

[Roehl_JC]

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Thank you Dr. V W Jagath Vasanthathilaka for your timely information and postings! Much appreciated!

 

[drjagathv]

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Thank you Dr. V W Jagath Vasanthathilaka for your timely information and postings! Much appreciated!

Viral studies seem have confirmed that it is due to H1N1 flu.

http://www.sundaytimes.lk/091108/News/nws_04.html

We are sad we lost a bright student from Trinity College Kandy unexpectedly. Medical profession and their immediate families are in the high risk group as we are exposed to all these infections. It is important to vaccinate those who handle patients and thier families first. Then the other high risk groups excluding those who are pregnant and likely to get complications. Afterwards all children need vaccination. Then the community, due to limited availability of the vaccine.

 

[drjagathv]

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Thank you Dr. V W Jagath Vasanthathilaka for your timely information and postings! Much appreciated!

Hope this information will help prevent and minimise the occurring of deaths and severe complications related to H1N1 infection. Public needs to be aware of the changing situation in order to face the realities effectively. This would also help Sri Lanka face the situation efficiently without messing it up. Preventive strategies needs to be adopted according to the changing situation and the new strategies should be current and up to date. Consultation of the clinicians in organising new strategies is vital.

 

[Gert van der Hoek]

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Viral studies seem have confirmed that it is due to H1N1 flu.

http://www.sundaytimes.lk/091108/News/nws_04.html

First Swine flu death in Lanka

By Kumudini Hettiarachchi

A 16-year-old boy in Kandy has died of H1N1 (Swine flu), the first reported death in Sri Lanka of this global pandemic flu, senior health officials confirmed yesterday.

The victim, son of two doctors, died on Wednesday night at the Kandy Teaching Hospital, the officials said. The Medical Research Institute confirmed that the death was caused by H1N1, the officials who declined to be identified, said.

Officials stressed, however, that there was no cause for alarm and urged the public not to panic. ?This boy had other complications including spinal and lung problems which could have aggravated the illness and placed him in a high-risk category,? one official explained.

They advised the public to go to the nearest hospital if anyone has a persistent fever for more than two days and flu-like symptoms as most state hospitals are geared to handle H1N1, while Base Hospitals which have consultants have been issued with anti-viral drugs to deal with the virus, an official said. The anti-virals should be taken only on the recommendation of a consultant who has clinically diagnosed H1N1 and deems it the right time to administer them, he said.

Although earlier H1N1 was diagnosed among those coming from abroad and their close contacts, the ?community spread? of this flu has now begun in the country. Up to October 15, 115 H1N1-affected people had been detected through the airport surveillance mechanism.

 

[Ronan Kelly]

Re: Sri Lanka - 1st Confirmed Death from H1N1 - Tamiflu Needed

Re: Sri Lanka - 1st Confirmed Death from H1N1 - Tamiflu Needed

Misdiagnosis cause of virus death


By Sandun A. Jayasekera
The failure to correctly diagnose the A/H1N1 virus has led to Sri Lanka?s first death from the disease, a Health Ministry spokesman said yesterday.

A 16-year-old student of Trinity College in Kandy died at the Kandy Teaching Hospital last Wednesday from complications arising from the influenza virus, A/H1N1. The student?s parents are medical professionals. He had been admitted to Hospital on Monday and diagnosed as suffering from pneumonia.

?The student?s condition worsened and the child passed away from lung failure. We got to know that it was a case of A/H1N1 only after several tests were carried out at the Medical Research Institute (MRI). Even the first tests at the MRI could not pin point the cause of the death. However, the Health Ministry extremely regrets of this unnecessary death and conveys its condolences to the child?s family,? the spokesman said and added that further tests would be carried out at the MRI.

Meanwhile, several samples of Indian made rubella vaccine had been sent to a laboratory in Canberra, Australia for further tests after the second death this year reported from Wariyapola.

The spokesman said the suspended rubella vaccination programme would be resumed in schools after a thorough investigation had been carried and necessary precautions were in place to prevent a repetition of incidents similar to those that took place in Matara and Wariyapola.

He said the Ministry had black listed five Indian drug suppliers over the supply of sub standard drugs.

Health Minister Nimal Siripala De Silva will take a final decision on the resumption of the school rubella vaccination programme once the reports from Canberra and the WHO were received.

http://www.dailymirror.lk/DM_BLOG/Sections/frmNewsDetailView.aspx?ARTID=67268

 

[drjagathv]

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Hope this information will help prevent and minimise the occurring of deaths and severe complications related to H1N1 infection. Public needs to be aware of the changing situation in order to face the realities effectively. This would also help Sri Lanka face the situation efficiently without messing it up. Preventive strategies needs to be adopted according to the changing situation and the new strategies should be current and up to date. Consultation of the clinicians in organising new strategies is vital.

Suspected patients with H1N1 need early treatment during the first 24 to 48 hours, one of the problems facing all these patients is that it takes a long time to confirm the diagnosis. Delays could lead to complications.

 

[drjagathv]

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

First Swine flu death in Lanka

By Kumudini Hettiarachchi

A 16-year-old boy in Kandy has died of H1N1 (Swine flu), the first reported death in Sri Lanka of this global pandemic flu, senior health officials confirmed yesterday.

The victim, son of two doctors, died on Wednesday night at the Kandy Teaching Hospital, the officials said. The Medical Research Institute confirmed that the death was caused by H1N1, the officials who declined to be identified, said.

Officials stressed, however, that there was no cause for alarm and urged the public not to panic. “This boy had other complications including spinal and lung problems which could have aggravated the illness and placed him in a high-risk category,” one official explained.

They advised the public to go to the nearest hospital if anyone has a persistent fever for more than two days and flu-like symptoms as most state hospitals are geared to handle H1N1, while Base Hospitals which have consultants have been issued with anti-viral drugs to deal with the virus, an official said. The anti-virals should be taken only on the recommendation of a consultant who has clinically diagnosed H1N1 and deems it the right time to administer them, he said.

Although earlier H1N1 was diagnosed among those coming from abroad and their close contacts, the “community spread” of this flu has now begun in the country. Up to October 15, 115 H1N1-affected people had been detected through the airport surveillance mechanism.

Suspected patients with H1N1 need early treatment during the first 24 to 48 hours, one of the problems facing all these patients is that it takes a long time to confirm the diagnosis.

 

[drjagathv]

Re: Sri Lanka - 1st Confirmed Death from H1N1 - Tamiflu Needed

Re: Sri Lanka - 1st Confirmed Death from H1N1 - Tamiflu Needed

Misdiagnosis cause of virus death


By Sandun A. Jayasekera
The failure to correctly diagnose the A/H1N1 virus has led to Sri Lanka?s first death from the disease, a Health Ministry spokesman said yesterday.

A 16-year-old student of Trinity College in Kandy died at the Kandy Teaching Hospital last Wednesday from complications arising from the influenza virus, A/H1N1. The student?s parents are medical professionals. He had been admitted to Hospital on Monday and diagnosed as suffering from pneumonia.

?The student?s condition worsened and the child passed away from lung failure. We got to know that it was a case of A/H1N1 only after several tests were carried out at the Medical Research Institute (MRI). Even the first tests at the MRI could not pin point the cause of the death. However, the Health Ministry extremely regrets of this unnecessary death and conveys its condolences to the child?s family,? the spokesman said and added that further tests would be carried out at the MRI.

Meanwhile, several samples of Indian made rubella vaccine had been sent to a laboratory in Canberra, Australia for further tests after the second death this year reported from Wariyapola.

The spokesman said the suspended rubella vaccination programme would be resumed in schools after a thorough investigation had been carried and necessary precautions were in place to prevent a repetition of incidents similar to those that took place in Matara and Wariyapola.

He said the Ministry had black listed five Indian drug suppliers over the supply of sub standard drugs.

Health Minister Nimal Siripala De Silva will take a final decision on the resumption of the school rubella vaccination programme once the reports from Canberra and the WHO were received.

http://www.dailymirror.lk/DM_BLOG/Sections/frmNewsDetailView.aspx?ARTID=67268

More and more Health Care personnel at risk at Kandy and Mathara.
http://www.colombopage.com/archive_091/Nov1257861767RA.html

 

[Fluman]

Who are in the high risk category for Swine Flu ?

Who are in the high risk category for Swine Flu ?

In most reports it is mentioned that certain underlying health conditions make Swine Flu deadly. Can we know what these conditions are ?

For instance, wheezing or Asthma is quite common amongst Sri Lankan children nowadays. Do children (say around 10 years) suffering from wheezing (for which inhalers are used), fall in to the high risk category for Swine Flu ?

Do children who have issues like Mitral Valve Prolapse, allergies, etc fall in to the high risk category ?

What are the conditions that make adults fall in to the high risk category ?

Thanks
Fluman

 

[Laidback Al]

Re: Who are in the high risk category for Swine Flu ?

Re: Who are in the high risk category for Swine Flu ?

In most reports it is mentioned that certain underlying health conditions make Swine Flu deadly. Can we know what these conditions are ?

For instance, wheezing or Asthma is quite common amongst Sri Lankan children nowadays. Do children (say around 10 years) suffering from wheezing (for which inhalers are used), fall in to the high risk category for Swine Flu ?

Do children who have issues like Mitral Valve Prolapse, allergies, etc fall in to the high risk category ?

What are the conditions that make adults fall in to the high risk category ?

Thanks
Fluman

Welcome to FluTrackers, Fluman.

Risk factors for H1N1 according to World Health Organization (November 2009) .

Risk factors for severe disease from pandemic (H1N1) 2009 virus infection reported to date are considered similar to those risk factors identified for complications from seasonal influenza. These include the following groups:

? Infants and young children, in particular <2 years
? Pregnant women
? Persons of any age with chronic pulmonary disease (e.g. asthma, COPD)
? Persons of any age with chronic cardiac disease (e.g. congestive cardiac failure)
? Persons with metabolic disorders (e.g. diabetes)
? Persons with chronic renal disease, chronic hepatic disease, certain neurological conditions (including neuromuscular, neurocognitive, and seizure disorders), hemoglobinopathies, or immunosuppression, whether due to primary immunosuppressive conditions, such as HIV infection, or secondary conditions, such as immunosuppressive medication or malignancy
? Children receiving chronic aspirin therapy
? Persons aged 65 years and older

From: Clinical management of human infection with pandemic (H1N1) 2009: revised guidance

link to full pdf document can be found at this page:http://www.who.int/csr/resources/publications/swineflu/clinical_management/en/index.html

 

[drjagathv]

Re: Who are in the high risk category for Swine Flu ?

Re: Who are in the high risk category for Swine Flu ?

Welcome to FluTrackers, Fluman.

Risk factors for H1N1 according to World Health Organization (November 2009) .

From: Clinical management of human infection with pandemic (H1N1) 2009: revised guidance

link to full pdf document can be found at this page:http://www.who.int/csr/resources/publications/swineflu/clinical_management/en/index.html

Antiviral drugs such as oseltamivir phosphate seem to be now available on prescription in Sri Lanka in-order to initiate early treatment for the patients belonging to the high-risk groups. We thank every body regarding your concern. We need the vaccine as well.

Dr. V W Jagath Vasanthathilaka.

 

[drjagathv]

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

First Swine flu death in Lanka

By Kumudini Hettiarachchi

A 16-year-old boy in Kandy has died of H1N1 (Swine flu), the first reported death in Sri Lanka of this global pandemic flu, senior health officials confirmed yesterday.

The victim, son of two doctors, died on Wednesday night at the Kandy Teaching Hospital, the officials said. The Medical Research Institute confirmed that the death was caused by H1N1, the officials who declined to be identified, said.

Officials stressed, however, that there was no cause for alarm and urged the public not to panic. ?This boy had other complications including spinal and lung problems which could have aggravated the illness and placed him in a high-risk category,? one official explained.

They advised the public to go to the nearest hospital if anyone has a persistent fever for more than two days and flu-like symptoms as most state hospitals are geared to handle H1N1, while Base Hospitals which have consultants have been issued with anti-viral drugs to deal with the virus, an official said. The anti-virals should be taken only on the recommendation of a consultant who has clinically diagnosed H1N1 and deems it the right time to administer them, he said.

Although earlier H1N1 was diagnosed among those coming from abroad and their close contacts, the ?community spread? of this flu has now begun in the country. Up to October 15, 115 H1N1-affected people had been detected through the airport surveillance mechanism.

Schools closed.

http://www.dailymirror.lk/DM_BLOG/Sections/frmNewsDetailView.aspx?ARTID=68379

 

[drjagathv]

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

First Swine flu death in Lanka

By Kumudini Hettiarachchi

A 16-year-old boy in Kandy has died of H1N1 (Swine flu), the first reported death in Sri Lanka of this global pandemic flu, senior health officials confirmed yesterday.

The victim, son of two doctors, died on Wednesday night at the Kandy Teaching Hospital, the officials said. The Medical Research Institute confirmed that the death was caused by H1N1, the officials who declined to be identified, said.

Officials stressed, however, that there was no cause for alarm and urged the public not to panic. ?This boy had other complications including spinal and lung problems which could have aggravated the illness and placed him in a high-risk category,? one official explained.

They advised the public to go to the nearest hospital if anyone has a persistent fever for more than two days and flu-like symptoms as most state hospitals are geared to handle H1N1, while Base Hospitals which have consultants have been issued with anti-viral drugs to deal with the virus, an official said. The anti-virals should be taken only on the recommendation of a consultant who has clinically diagnosed H1N1 and deems it the right time to administer them, he said.

Although earlier H1N1 was diagnosed among those coming from abroad and their close contacts, the ?community spread? of this flu has now begun in the country. Up to October 15, 115 H1N1-affected people had been detected through the airport surveillance mechanism.

H1N1 infections seem to be widespread.
http://www.dailymirror.lk/DM_BLOG/Sections/frmNewsDetailView.aspx?ARTID=68519

 

[drjagathv]

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Re: Sri Lanka - 1st Suspected Death from H1N1 - Tamiflu Needed

Hope this information will help prevent and minimise the occurring of deaths and severe complications related to H1N1 infection. Public needs to be aware of the changing situation in order to face the realities effectively. This would also help Sri Lanka face the situation efficiently without messing it up. Preventive strategies needs to be adopted according to the changing situation and the new strategies should be current and up to date. Consultation of the clinicians in organising new strategies is vital.

Sri Lanka Health Ministry orders H1N1 vaccine amid rising death toll
Sat, Nov 21, 2009, 09:17 pm SL Time, ColomboPage News Desk, Sri Lanka.

Nov 21, Colombo: Sri Lanka's Health-care and Nutrition Ministry has placed an immediate order for the WHO approved Novel Influenza (A) H1N1 vaccine amid the rising death toll from the epidemic.

Adding to the death toll rising alarmingly due to the rapid spread of A/H1N1 another death was reported yesterday evening from Kurunegala.

A 58-year-old school principal, K.W Gunathilaka died after he was admitted to the Kurunegala Hospital due to the suspected A/H1N1.

The patient died just a day ahead of his daughter's wedding scheduled to take place today, the family sources said.

Kurunegala Hospital said that over 28 patients are currently receiving treatment at the hospital for AH1N1.

"There have been 258 cases reported in the country so far and there could be a lot more unconfirmed cases," the Health Ministry spokesman, . M. B. Wanninnayake said.

Five deaths have been reported so far, all from the Kandy District and three out of five dead patients were pregnant women.

The Ministry expects to receive the vaccine by December. It will be given on a priority basis to the people of high risk groups including pregnant mothers, infants below six months, elderly above the age of 60 and patients with chronic diseases.

Health-care professionals who handle these patients also need vaccination in order to prevent rapid dissemination of infections. Already a child of a medical professional has expired due to H1N1 infections in Kandy.