An Analysis of Influenza in India: Epidemiology and Management

This essay provides a comprehensive overview of influenza in India, examining its background, epidemiology, and the challenges it poses to public health. It delves into the various types of influenza, including seasonal and avian strains, and discusses the country's vulnerability due to its low-middle income status. The essay explores prevention and control measures, including vaccination strategies, and critically appraises the effectiveness of interventions. It highlights the importance of surveillance and the need for improved healthcare infrastructure, especially in rural areas. The essay presents statistical data on the disease burden, including morbidity and mortality rates, and analyzes the seasonal patterns of outbreaks. It also discusses the role of the government and health organizations in managing the influenza epidemic. The essay concludes by suggesting alternative solutions and emphasizing the need for a multi-faceted approach to mitigate the impact of influenza in India.

ESSAY
(Influenza in India)

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Background to country and Influenza.........................................................................................1
Prevention and control measures................................................................................................6
Critical appraisal of Influenza disease control intervention in India..........................................7
Alternative solutions...................................................................................................................8
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
Influenza is the respiratory illness which is an infectious disease. It is caused by influenza
virus. This virus is transmitted from one to another person through air, droplets, etc. There are
several kinds of Influenza such as Type A, B and C. India is the low middle income country
where number of cases of seasonal and avian influenza are very high. Present study will discuss
about influenza infectious disease in India. It will describe prevention and controlling measures
of this illness.
MAIN BODY
Background to country and Influenza
Influenza is the common infectious disease that impacts on respiratory system. There are
many people who use word “Flu” for this infectious illness. It occurs mostly in children but it
also takes place in adults (Tharakaraman and Sasisekharan, 2015). Incubation period is the time
in which patients acquire this infection and symptoms are shown within the body. Incubation
period for this disease is about 1 to 4 days, averagely it is about 2 days. This illness gets spread
from one to another through respiratory droplets' transmission. Transmission is done through
close touch with source and recipient person (Koul and et.al, 2014). The global annual rate of
people who suffer from this illness are approx. 5-10%. Among them, there are 20-30% children
who get affected by this illness mostly. This viral infection affects nose, throat, bronchi, etc.
Though this is the common disease and people can get recovered soon within one or two weeks
without taking any treatment, but, sometimes, it turns into big illness if individuals will get failed
to take care of themselves properly. Infection sometimes lead to complicated situations such as
pneumonia, death, etc. (Chadha and et.al, 2015).
Influenza is the viral disease that can be occurred in various forms such as pandemic,
epidemic, sporadic cases etc. Initially, Influenza seems like common cold in which individual
suffers from runny nose, sneezing. But due to this virus cold gets developed slowly. At that time
person suffer from fever over 100.4 F. Patient faces aching in muscles, bank and arms.
Furthermore, individual also feel headache, sore throat and nasal congestion. Most of the people
who goes through these symptoms do not prefer to go hospitals because they think it is seasonal
fever thus, they treat themselves at their home only (Gnatiuc and et.al, 2015).
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Sometimes, flu creates complicated situation for the suffered person. Complications of
Influenza are like pneumonia, ear infection, sinus infections, heart failure, asthma, etc. It is the
infectious disease that transmits from one person to another. Poor health conditions or weak
immune system is another major cause of occurrence of this Influenza illness (Pawar and et.al,
2014). It is contagious issue that can be spread one to another easily. Flu viruses live on the
surface for approx. 24 hours and if the person comes in touch with the surface then the individual
may get suffer from this illness. India is the nation where more than 40% of mothers do not take
this flu seriously. Poor knowledge and limited information is the main cause of increasing rate of
these patients. Seasonal outbreaks of flue is the common situation ion India in the Monsoons
seasons. This increases risk among all people to get suffer from this illness.
Epidemiology
World health organization (WHO) has given its report on Influenza and it is stated that
there is the need to enhance surveillance on this medical illness within India because despite of
effective prevention methods or treatment, number of patients are increasing at a rapid speed.
Statistical records of 2013 show that burden of disease is increasing in India. Many children less
than five years get admitted into hospitals every day. It is recorded that India is the country
where many people live in rural areas (Parida and et.al, 2016). These children and their parents
are unaware with the causes of Influenza. In the year 2007, approx. 7% people have been
accounted with influenza and they have been admitted into Delhi hospital. It mostly takes place
in the rainy season in between month of June-July. In this seasonal time, every year, approx. 20-
42% population of India suffer from Influenza (Nagarajan and et.al, 2017).
The global annual attack of Influenza virus in India is estimated to be approx. 5% to 10%
in adults and 20% to 30% in children. Worldwide, these annual surveillance estimated result to
be about 3 to 5 billion cases of severe illness and approx. 250,000-500,00 deaths. Influenza virus
in India confirmed nearly 30,000 laboratory tests to be positive, in which more than 1700 deaths
by March 2015. Most of the cases are from states of Rajasthan, Gujarat, Delhi, Jammu and
Kashmir, Maharashtra, Madhya Pradesh, Telangana, Karnataka and Tamil Nadu. Increase in
number of Influenza patient, Central and State Health Department organized different activities
which includes detailed surveillance of virus, supplying medium and diagnostic reagents to the
hospitals; making oseltamivir available through public health system; scheduled different
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chemists and educating the public about this virus through regular information. In 2009, India
reported around 27,236 confirmed laboratory test of influenza with 981 deaths reported.
According to the data available through Ministry of Health and Family Welfare, since
2010, more than 62,000 positive case of Influenza virus has been recorded in India with nearly
5000 deaths (Mishra, 2015). As per the guidelines of The Government of India, Influenza
patients are divided into three categories- Category A which includes mild cases where no
laboratory testing or antiviral treatment is needed for the patient. In Category B, high-risk
patients are included for example, children, pregnant women, persons aged ≥ 65 yr and people
with chronic disease. At last, Category C includes patients with severe cases who are
hospitalized and needs laboratory testing and oseltamivir treatment.
Based on the Case-fatality Ratio (CRF), number of reported death from Influenza is 5.8%
confirmed laboratory test in January-March 2015 in India. Influenza virus detection peaked
during the rainy season in June-July when influenza accounted for 20-42% of monthly acute
medical illness hospitalizations (Tosh and et.al, 2016). In 2015, Mumbai recorded nearly 50% of
Influenza causalities and one-fourth of the confirmed cases are detected in the country since
January. The state has recorded so far 4014 positive cases with 414 deaths. Overall, death rate
have jumped three times higher in the year 2015, affecting nearly 18,000 and claiming over 871
lives across India (Sundaram and et.al, 2015).
India is the country in which large number of population gets suffered from this illness
every year. Health experts and government agencies continuously work for minimizing the
number of Influenza patients, for that they suggest that the best way to protect these people from
suffering flue is provided them vaccination (Assessment of burden of seasonal influenza in India
and consideration of vaccination policy, 2013). If children are getting vaccinated every year then
it improves their immune system and they become able to fight with this virus. There are two
main types of vaccination that are available in India that provides by doctors from new born
baby to 5 year children (Tosh and et.al, 2016). Flu shot and nasal spray flu vaccines are available
in the India. Flu shot is the type of vaccination which is inserted through needle. Medical
professionals usually insert it in the arm. Children older than 6 months can be vaccinated and
people those who are suffering from chronic medical conditions can take vaccines. Furthermore,
Nasal spray flu vaccine is another type of epidemic that is suggested by the doctors to parents for
their new born babies (Tharakaraman and Sasisekharan, 2015).
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India is the country where number of cases of Swine flu are high. It is Influenza A
(H1N1) pdm09 virus. In the year 2009-2010 approx 50000 people in India were got affected by
this illness. Statistical records of 2017 shows that One out of 25 people died with this infection in
India. This is the attack rate of Influenza virus in the India. In this year 11752 people have been
diagnosed with H1N1 infection. It is estimation that 0.5 to 1.5% people those who coming in
touch with Influenza virus get died in the nation (Assessment of burden of seasonal influenza in
India and consideration of vaccination policy, 2013).
In the same year, Maharashtra has found 1978 cases of this illness. People those who
have been died with this disease are between 20 to 45 years of age. Kerala is another state in
India where number of cases of Influenza diseased persons are high. Medical professionals
examined condition of patients and they suggest Oseltamivir to the person those who are infected
with H1N1. Patients can respond immediately and doctors needs not to wait for longer duration
for laboratory testing in order to confirm this illness. Statistical records show that In Maharastra
there are 50% patients those who have been died after giving Oseltamivir only between 3 to 5
days on showing symptoms (This map shows how severe India’s swine flu outbreak is this year,
2017).
Ministry of health and family welfare have identified that one of the main cause high
mortality in India is delay in getting treatment. There are many patients those who come to
hospitals at right time but medical professional do not provide them correct treatment on time. In
such condition there medical situation gets worst. It is essential that individual get treatment for
this illness within 48 hours of being infected (THE 1957 PANDEMIC OF INFLUENZA IN
INDIA, 1959). If the patient gets failed to get proper treatment within this period then it may
leads to several complications in the human body which leads to death some times. Health
ministry of India has shown that 22186 cases of swine flu has been diagnosed in this year. There
are 488 cases in Maharashtra whose conditions are worst and among them there are 343 patients
those who have been died with the disease.
Disease trends
Uttar Pradesh is another state in India which is also facing serious issues due to influenza
virus. In the year 2009, 2798 cases of H1N1 has been reported in UP which was 871 high as
compare to 2009. Rajasthan is another state which is facing the major issue due to this virus.
There were 910 cases have been reported with this virus, in Telangana it is 173. Madras, Mysore
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and Kerala, etc. many locations are here in India where number of infectious patients are high.
They have suffered from this virus because hundreds of passengers came to the country from
Singapore. They were suffering from this illness. Attack rate of India is high of this virus. 6-10
year children maximum get suffered from this illness in the month of June whereas 0-5 group of
people get suffered in month of July (This map shows how severe India’s swine flu outbreak is
this year, 2017).
There are only limited number of research centres in India those which are working on
this Influenza. Systematic laboratory based surveillance on Influenza virus has been done in
limited areas of India. It is found that there are many rural areas where many people are suffering
from this flu. India is the country where in every 4 months season gets changed. There are three
basic patterns of Influenza circulation in India (Assessment of burden of seasonal influenza in
India and consideration of vaccination policy, 2013). Statistical records of 2015 shows that there
were many people hospitalized in Kashmir, India those who were suffering from chronic
obstructive pulmonary disease. After diagnosis it was found that maximum of them are infected
by Influenza virus. At that time many patients were dying in hospitals because they have failed
to take treatment at the initial phase of this disease (Assessment of burden of seasonal influenza
in India and consideration of vaccination policy. 2013.).
Incidence
Some statistical records show that in the year 2013 there were 1726 patients were
diagnosed with A (H1N1) Influenza and seasonal Influenza in Rajkot city, India. There were
29.6% causes of H1N1 Whereas 70.4% cases of seasonal Influenza. 5.5% prevalence of
pregnancy is higher as compare to general population (Chadha and et.al, 2015). There are many
virulence people in India among whom this disease gets developed and these people gets infected
seriously which creates complicated situation for then which leads to death. Influenza A takes
place mostly in women with maternal mortality. It impacts adversely on their fetal outcome as
compare to normal ladies. I
That is why when they are in incubation period then they do not go to hospitals for
routine check-up. It is essential for the person that to take proper guidance at the incubation
period so that this issue can be resolved through basic medicines at the initial phase. Government
of India needs to improve vaccination rates and have to make national vaccination policies. This
can help in preventing 1.2 billion population in India. Medical professionals are required to
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educate pregnant women so that they can take precautions and can prevent themselves from this
illness (Parida and et.al, 2016).
Risk groups
Young children and adults older than 65 year are the risk groups. These people can get
affected by this virus easily. Attack rates of this virus in this group of people are high. As there
are 5-10% attack rate in adults in India and 20-30% rate in children of the country.
Incidence
Prevention and control measures
NHS is continuously trying to make effective control over Influenza disease. India is the
country where number of cases of people those who are suffering from this illness are high.
Influenza vaccines are considered as one of the effective controlling measure. That assist in
protecting people from this illness. In the recent time doctors provide vaccines to new born baby
so that individual can get protected from this illness for longer duration. Children 6 months to 8
year need to get these vaccines. Children those who are of 9 year old needs to get 1 dose of flu
vaccine. It is the medical problem which is occurred due to viral infection. In order to treat these
people, medical professionals provides doses to the patients so that health can be improved soon
(Influenza (flu), 2018). Most common medicines that are prescribed by doctors are oseltamivir,
Zanamivir. In this illness individual feels headache in arm and in muscles as well. Thus,
professionals prescribes some painkillers such as aspirin etc. so that individual may get
recovered soon from this pain. The best medicines for this illness is acetaminophen or naproxen.
Medical professionals suggest to the suffered persons that to avoid close contact from the
people those who are sick. They have to make distance so that other do not get affected from this
virus. Patients needs to stay at home and have to take proper care;. They have to clean hands
properly and have to take care of their life style. Individual can be prevented from flu by taking
support of antibiotics. Painkillers give relief to the person and help in recovering soon from this
illness. Patients have to consume plenty of liquids. This aids in improving the condition of the
person soon.
Antiviral drugs are the best treatment for the Influenza. There are many children
those who get suffered from this illness and doctors prescribe them these medicines.
Furthermore, medical professionals suggest everyday precautions in order to prevent people from
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this illness. They suggest that individuals needs to cover their noise and mouth with tissue paper
so that they can be prevented from dust and other infectious virus.
Critical appraisal of Influenza disease control intervention in India
As per the view of Nagarajan and et.al, (2017) Influenza vaccines is a yearly vaccines
given to a person that protects them from getting flu or any viral respiratory disease that can
easily spread.
Sundaram and et.al, (2015)argued that There several types of vaccines available in India
for Influenza virus such as, Flu shot and Nasal spray. Flu shot: This vaccine is typically given to
those who are six months old and more. It's an inactive vaccine which is made from dead forms
of viruses. These dead germs cannot affect the body . People in between 18 to 64 years of age
can opt for an intradermal flu shot. In this vaccination, the needle goes into the top layer of the
skin instead of the muscle. Nasal spray: The nasal spray vaccine is a Live Attenuated Vaccine or
LAV. It is made from live bur weakened influenza viruses (Influenza (flu), 2018).
According to Chadha and et.al, (2015) There are poor intake of vaccination for influenza
virus. Thus, there are many people those who are at high risk, especially women. If the lady gets
suffer from this flu then it may impact negative on mother and foetus as well. In order to prevent
these patients doctors in India suggest maternal influenza vaccination to the ladies those who are
pregnant. This vaccine develops antibodies agents in the body that helps in fighting against this
virus. India is the country where people are not really aware with the causes, symptoms and
prevention of influenza disease.
As per the view of Parida and et.al, (2016) India is the country where limited
vaccinations are available. That is why doctors have to provide these vaccines in order to protect
persons from the illness. Though, these vaccines are effective in order to prevent people from
coming in tough with Influenza virus. Mishra, (2015) argued that washing hands is the efficient
prevention method. If the person is taking care of hygiene then it can help the individual in
avoiding disease. Living in the clean environment is the best way of protecting people from such
type of disease.
According to Tosh and et.al, (2016) pain killers are not the good options because some
times these painkillers such as aspirin etc. create allergy within children and adults. People above
65 years suffer from many diseases such as BP, heart issues etc. In this age if they take such type
of medicines then it can create issue within their body. Sundaram and et.al, (2015) stated that
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vaccination is the best prevention method when medical professional insert vaccines to the
children in early age then it supports them in preventing themselves from various kinds of virus.
It develops anti fighting agents within their body that helps them in protecting themselves and
living healthy. These vaccines improve immune system of the person and supports in avoiding
many diseases.
Alternative solutions
In order to control over the Influenza disease it is essential for the medical professionals
that to provide them vaccination. But alternative solution to minimize number of cases of
Influenza in India are taking care of general hygiene. It is considered as one of the effective
solution. If the person take care of their hygiene then person may improve their condition soon.
They need to ensure that they live in clean environment. They need to avoid in coming in touch
with infected person. Apart from this, adequate rest, taking appropriate nutrition, antipyretics, are
several ways to control over this illness. Antiviral medicines are effective for preventing people
from this Influenza disease. Political parties government has to provide more funds to the health
and social care sector so that development in HSC can be taken place. This can help in
improving treatment process which will help in minimizing death rate of Influenza patients.
CONCLUSION
From the above report, it can be concluded that Influenza is a common flu but it is very
important to take proper care at initial phase. India is a country where people do not have good
knowledge about this illness which creates problems in them and enhance death rate. Medical
professionals are required to educate people, mainly the pregnant ladies so that they can take care
of themselves and improve their conditions soon. Effective vaccination policies can support in
preventing people from influenza disease.
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REFERENCES
Books and Journals
Chadha, M. S. and et.al., 2015. Dynamics of influenza seasonality at sub-regional levels in India
and implications for vaccination timing. PLoS One. 10(5). pp.e0124122.
Gnatiuc, L. and et.al., 2015. Gaps in using bronchodilators, inhaled corticosteroids and influenza
vaccine among 23 high-and low-income sites. The International Journal of Tuberculosis
and Lung Disease. 19(1). pp.21-30.
Koul, P. A. and et.al., 2014. Differences in influenza seasonality by latitude, northern India.
Emerging infectious diseases. 20(10). pp.1723.
Mishra, B., 2015. 2015 resurgence of influenza a (H1N1) 09: Smoldering pandemic in India?.
Journal of global infectious diseases. 7(2). pp.56.
Nagarajan, S. and et.al., 2017. Novel reassortant highly pathogenic avian influenza (H5N8) virus
in zoos, India. Emerging infectious diseases. 23(4). pp.717.
Parida, M. and et.al., 2016. Emergence of influenza A (H1N1) pdm09 genogroup 6B and drug
resistant virus, India, January to May 2015. Eurosurveillance. 21(5).
Pawar, S. D. and et.al., 2014. Immunity status against influenza A subtype H7N9 and other avian
influenza viruses in a high-risk group and the general population in India. The Journal of
infectious diseases. 210(1). pp.160-161.
Sundaram, N. and et.al., 2015. Community awareness, experience and preference for use of
pandemic influenza vaccines in Pune, India. Tropical Medicine & International Health.
20. pp.93.
Tharakaraman, K. and Sasisekharan, R., 2015. Influenza surveillance: 2014–2015 H1N1
“swine”-derived influenza viruses from India. Cell host & microbe. 17(3). pp.279-282.
Tosh, C. and et.al., 2016. Multiple introductions of a reassortant H5N1 avian influenza virus of
clade 2.3. 2.1 c with PB2 gene of H9N2 subtype into Indian poultry. Infection, Genetics
and Evolution. 43. pp.173-178.
Online
Assessment of burden of seasonal influenza in India and consideration of vaccination policy.
2013. [PDF]. Available through <http://www.gjmedph.com/uploads/R1-Vo5No5.pdf>.
Influenza (flu). 2018. [Online]. Available through <https://www.mayoclinic.org/diseases-
conditions/flu/symptoms-causes/syc-20351719>.
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THE 1957 PANDEMIC OF INFLUENZA IN INDIA. 1959. [PDF]. Available through
<http://apps.who.int/iris/bitstream/handle/10665/265321/PMC2537734.pdf?
sequence=1&isAllowed=y>.
This map shows how severe India’s swine flu outbreak is this year. 2017. [Online]. Available
through <https://scroll.in/pulse/842866/this-map-shows-how-severe-indias-swine-flu-
outbreak-is-this-year>.
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