Draft Action Plan for Pandemic Preparedness and Response

Letter from Secretary(H) to Chief Secretaries of all States/UTs

Letter from Joint Secretary(H) to Secretaries/Principal Secretaries of all States/UTs

Daily Press Releases

CD ALERT

Swine Flu- Clinical Management Protocol and Infection Control Guidelines

Travel Advisory to the Public

List of H1N1 affected countries as on 16.6.2009

Guidelines for Sample Collection and Handling of Human Clinical samples for Laboratory Diagnosis of H1N1 Influenza

List of Isolation facilities and nodal officers of the States

Fact Sheet on Influenza A [H1N1]

With the first swine flu death being recorded in INDIA yesterday, it will be all important to keep a ready recknor at hand. More so we need to be aware of the correct symptoms and the right place for treatment. So in case we have someone who is seen to have symptoms we could guide them to the right hospital. The attached presentation would give you additional details about the swine flu, its symptoms and the actions that need to be initiated. As a Unified Force we can stop the spread of this EPIDEMIC and cure the affected ones with timely and correct treatment.

Please forward the brochure to as many known people as possible so as to make them aware and be part of the Unified Force.
Take care.

Culled from an email received from a colleague.

Sneezing, watery nose, sore throat, body ache, fever?
Swine Flu?

Almost all of us, at least once or twice a year, with season change, get this common ailment with varying degree of severity, some times lasting for 48 hours, gradually with waning of symptoms as the days go by. Some times we go to Doctor or more often than not, we self medicate, some taking happily over the counter “Cold medicines” (most dangerous!), or some times taking just painkillers lying in our medicine chest
(with expiry date long over!), and claim ourselves to have cured ourselves!! Those of us, who go to our GP, take his advice of bed rest rather lightly but do take whatever Antibiotics he prescribes. Some take “homeopathic” pills and scrupulously avoid any allopathic drugs. Whatever measure we take out of above choices, most of the time all the symptoms do subside within 3-4 days and everything is forgotten as a “common flu”!! Even in common medical parlance, it is axiomatic to say that in “flu” if you take antibiotics, you are cured in just one week and if you do not take medicine, you suffer for whole seven days!! (Actually antibiotics do not have any effect on Viruses. They only act on Bacterial infections- which is the next progression of the disease.)

All that changed suddenly, with arrival of novel A H1 N 1 Virus- a subsection of myriads of so called “flu” viruses but a new strain and a much milder version than the other more common lethal versions!!

Earlier, so called Bird Flu, which produced Systemic Acute Respiratory Syndrome (SARS Virus) which was potentially much more lethal, had also created a similar frenzy world over, but got quickly controlled in its spread, making it endemic, mainly confined to South East Asia. This time, before one could pinpoint the new virus, it got quickly out of hand, starting in Mexico, spreading mainly in Western countries and now in over 134 countries world over and in India- making it Pandemic. The problem arose as it took some time to realize that it was a new virus, it took some time to produce a reliable Lab test (it is expensive and sophisticated test requiring sophisticated Lab Facilities) and selecting a specific Anti Virus medicine. Antibiotics do not work. All this, and its close similarity at initial stage to “common flu” lead to slipping out of control, and spread like wild fire, making it pandemic. This is true of all the new viruses which affect mainly upper respiratory tract infection. It is the “newness” of the virus, which makes it long time to detect, develop effective Lab test and produce particular anti virus vaccine or treatment- thus making it more dangerous than the usual flu virus.

The media lapped it up as “Breaking News” and now it has become daily news item of reporting one more death or one more city being affected!! But the fact is at the time of writing this article in total 69 deaths have taken place, with 3095 confirmed cases, in the population of 1.2 Billion. In contrast hundreds and thousand time more people are dying of road accidents, TB, Malaria and even simple diseases like diarrhea, and dysentery. But then, they are not fashionable diseases, nor are they latest viruses, and hence not a “Breaking News” item!!

It is pertinent to note, that in any virus infection, including that in “common Flu” variety, sometimes immunity falls down to dangerous level, and Bacterial infection quickly takes over, affecting Respirator System, producing Pneumonia, and if not treated aggressively at the beginning of Respiratory tract infection with appropriate antibiotics and with appropriate dosage and for appropriate length of time, it can lead to a critical condition.

Failure to recognize this development in the course of illness, can lead to serious situation requiring ICU admission in the hospital. It also requires a constant monitoring of vital signs, Oxygen saturation and concentration in the blood and if found wanted, to take over the respiratory function with artificial ventilation (Ventilator). In most of the time with these aggressive measures, Pneumonia will subside and there is full recovery. How ever those with co-morbid conditions like failing heart, Diabetes, elderly with poor respiratory reserve and children- the vulnerable group, may not respond and go into almost fatal Acute Respiratory Distress Syndrome, with multi organ failure where fatality rate is very high. Many elderly people who die of Pneumonia every year, have this origin of the common flu, not recognized early of its Bacterial invasion phase and hence under treated due to failure to recognize the seriousness of the situation until the final hours , when it is too late.
This is happening almost daily all over without much of a fuss or mention in “Breaking News”!! In fact during the seasonal change in weather or at the onset of winter (October, November December) for this vulnerable group it is worth considering Anti Influenza (Flu) vaccination. Epidemic of Community Acquired Pneumonia is much more common in these seasons.

How should then we react to H1N1 scare? Should we brush aside as media hype? Or should we start going about with mask or handkerchief looking like Bandit Queens!
We should do neither. It is important to realize Flu is a serious situation which should cause concern, not alarm, H1 N1 not withstanding, - calling for preventive measures and once infected close monitoring, appropriate bed rest, certain precautions (no aspirin), and once early signs of Respiratory Tract infection appears, calling for aggressive treatment with right antiviral drug and right antibiotics for right length of time. More than 98% chance that you will recover.


It is now well recognized that A H1N1 infection can be detected with specific tests to pinpoint in affected people and having a specific antiviral drug (Oseltamivir or Zanamvir)) Tamiflu® to cure it- provided it is given in right time i.e. within 48 hours of infection to be 100%effective. And there lies the catch-22 question. When do we suspect that it is not a seasonal flu but the new variety?



High degree of suspicion is the key word.

If fever persists or becomes very high with newer symptoms appearing as breathing difficulty or asthma, vomiting or diarrhea etc, then you require hospital admission in ICU without any further delay. You should have a list of hospitals both Government and Private, where H1N1 Virus detection tests are available and where they can start you with Tamiflu® even before the test results arrive and on high suspicion especially when the results take undue long time to arrive. You should insist on that*. Time is essence. You therefore need to involve your family physician from the early stage of illness, so that he can monitor you closely from time to time and take appropriate steps.

What about Preventive measure? Whenever there is seasonal change, and increased frequency of Cold and Cough cases- the so called “flu” you hear, you should avoid crowded halls or confinement in a crowded space. Stop smoking if you have not done so already, take a daily dose of Vitamin C and do not neglect cold and cough and body ache. You need to take immediate action before it takes a serious turn. This is more so for vulnerable group. If some one sneezes repeatedly or coughs, ask him to cover his mouth and nose with handkerchief and keep a safe distance from the person (minimum 3 ft). Masks are needed for those who are in hospitals treating you and those in isolation ward with established H1N1 infection afflicted.

Always wash your hands with copious soap and water as often as you can and certainly when you come back home from work.

Wishing you a very happy Puja!! Avoid smoky areas in Puja pandal. No “dhunochi” natch!!

* Personal View.

(This article is personal view of author for public general information and purposely dealt in layman’s language. It should not be considered as treatment guideline.)

Some dos and don’ts in “Flu Season”
Wash your hands as often as possible (For 1 minute). For children (Complete singing Happy Birthday 4 times while washing hands!)

Avoid crowded places/ Smoky Rooms

Stop Smoking if not done already

Use Tough Tissue Paper to block mouth and nose while sneezing and coughing and discard once soiled.

Keep safe distance from person sneezing, coughing (minimum 3 ft)

Isolate family member in a separate room with suspected flu symptoms

Bed Rest, Bed Rest, Bed Rest.

Paracetamol 8 hourly for Fever Not Aspirin. Plenty of Fluids. Vitamin C 1gm daily.

See your Family Physician early.


Subir Ray
SSE/W.Rly.