H3N2 Aussies Flu, a near epidemic in Australia, UK and USA: H1N1 in Rajasthan India

H3N2 Aussies Flu, a near epidemic in Australia, UK and USA

H1N1 in Rajasthan India

The flu is rapidly spreading across the US, UK and Australia.

Not only did it start early, but it seemed to occur all over the country more or less simultaneously.

The predominant flu strain is H3N2. Vaccine effectiveness typically ranges from 40 to 60 percent in a good year. Preliminary estimates from last year show the vaccine was 40 percent effective in the U.S., similar to 2014-2015. But concerns have been raised about this year’s vaccine after an editorial published in the New England Journal of Medicine last Thursday said it was only 10 percent effective against H3N2 in Australia.

Additionally, years in which H3N2 is the predominant influenza strain tend to have higher death rates, with approximately 20,000 deaths in the 2012-2013 and 2014-2015 seasons when H3N2 predominated.

Good news is that H3N2 flu is quite susceptible to the available flu medications, like Tamiflu, also known as oseltamivir. Remember, it is most helpful if taken within 48 hours of the start of the flu. It can take up to two weeks for the body to build up defences against the virus.

It is especially important for pregnant women to get the vaccine. There is dual benefit for the pregnant woman to get vaccinated. Not only will she get protection, but she’ll also pass those antibodies along to her infant, which will protect them for the first 6 months of life when the infant is too young to get the vaccine. And the vaccine is safe for pregnant women and the fetus.

For those who contract the flu, it could make symptoms less severe. Next, make sure to wash hands carefully to limit the spread of the virus and try to avoid close contact with sick people.

People who get sick should also keep up with fluids — and seek medical attention if they start to feel worse or develop shortness of breath, worsening congestion or cough.

Public Health Concerns

1.       Trace the first case of H3N2 in India

2.       High risk people to consider vaccinations

3.       Do not allow any person suffering from flu to enter public places

4.       Give compulsory off to people suffering from flu

5.       Learn cough etiquettes and respiratory hygiene

New strain of H1N1 virus in Rajasthan

New strain of H1N1 virus in Rajasthan

Doctors should follow the national flu guidelines; people should follow basic hygiene 

New Delhi, 07 January 2018: Recent estimates have indicated that there have been more than 100 cases of flu in Jaipur, Rajasthan with over 10 deaths within a one-week duration. The cases are due to a new strain in the H1N1 virus called the Michigan strain. H1N1 is associated with increased hospitalizations and deaths among elderly adults and young children.The Rajasthan government on January 3 sounded an alert in the state after more than 400 people were diagnosed positive for the swine flu virus in December 2017.

About 241 swine flu deaths have occurred in the state since January 2017. Apart from this, 3,033 hospitals have swine flu screening centres, 1,580 isolation beds, 214 ICU beds, and 198 ventilators for patients affected by the swine flu virus.

Speaking about this,Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) andImmediate PastNational President Indian Medical Association (IMA), said, “Though the virus may be less dangerous, it is certainly more contagious. As the virus has undergone a change, it is likely to infect more people who have not developed immunity to it yet.Flu (influenza) viruses are divided into three broad categories: influenza A, B or C. Influenza A is the most common type. H1N1 flu is a variety of influenza A.H1N1 indicates the viral serotype.It is a kind of shorthand for characteristics that identify the virus to your immune system and allow the virus to enter your cells. There are many different strains of H1N1 flu.The virus spreads through droplet infection and spreads with a person coughs, sneezes, sings or speaks. The virus can cover only a distance of 3 to 6 feet.”

Some symptoms of H1N1 include: muscle pain; dry cough; diarrhea, nausea, or vomiting; chills, fatigue, or fever; headache, shortness of breath, or sore throat.

Adding further, Dr Aggarwal, Vice President CMAAO, said, “All Rajasthan doctors are advised to administer antiviral drugs to all hospitalized, severely ill and high-risk patients with suspected or confirmed influenza. It is also imperative to follow the national flu guidelines.”

Some take home messages

• No fever no flu; cough, cold, and fever indicate flu unless proved otherwise
• No breathlessness no admission
• People with co-morbid conditions, pregnant women and the elderly should not ignore flu
• For both hospitalized patients and those managed in the outpatient setting, isolation precautions should be implemented.
• Hygienic techniques such as handwashing have been shown to prevent the spread of respiratory viruses, especially from younger children.
• Health care workers in Asia often wear surgical-type face masks to prevent their acquisition of respiratory tract infections. Such masks are increasingly used by travelers for the same purpose.Wear a mask when within three feet of the patient.Health care workers should also use gloves, gowns, and eye protection, as appropriate, when in contact with infected patients
• Gargling with water three times daily or gargling with povidone-iodine is recommended.
• Patients and visitors should cover their nose or mouth when coughing, promptly dispose used tissues, and practice hand hygiene after contact with respiratory secretions.
• Let the patient remain in a single room. All contacts should wear simple masks when within three feet reach. Hand wash after coming in contact with respiratory secretions. Consider flu vaccines for contacts.

Now blood donors can avail official leave on the day of donation

India faces a shortage of 10% relative to its blood requirements

The Heart Care Foundation of India (HCFI), which is celebrating 25 years of Perfect Health Mela   this year, lauded the order from DoPT approving 4 days special casual leave each year for blood donation or apheresis donation at any licensed blood bank for all Central Government employees. The aim is towards ushering in 100% voluntary blood donation by 2020.

Every year India requires about 5 crore units of blood, out of which only a meager 2.5 crore units of blood are available. India faces a shortage of 10% relative to its blood requirements. In absolute terms, this means covering a shortfall of over 12 lakh units. Given that the eligible donor population of India is more than 512 million, this deficit is alarming.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “India has huge population of more than 1.3 billion, but is still short of blood. Blood donation is a requirement of the society. All donations should be voluntary. One should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion. The move by DoPT is a very positive one and will hopefully encourage more and more people to come forward and donate blood. My humble suggestion is that all private sector establishments should also adopt this rule.All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.”

Under the new National Blood Transfusion Council regulations, no blood is to be wasted. The surplus left over plasma is fractionated to manufacture products like albumin and intravenous immunoglobulins (IVIG). The blood that is donated in voluntary blood donation should be maximally utilized.

Adding further, Dr Aggarwal, Vice President CMAAO, said, “Now no camp should be organized for ‘whole blood donation’. Instead components-only blood donation camps should be organized. One unit of blood collected can be used to help 3 to 4 patients, instead it is being wasted as whole blood depriving another patient in need. And, voluntary blood donation camps should be now called ‘blood component donation’ camp and not just blood donation camp. So, if the blood being donated is collected in a single bag, do not give blood. Usually two component bags are used. 100 ml bags should be promoted for pediatric use.”

Some things to consider for donating blood are as follows.

• Prepare yourself by having enough fruit juice and water in the night and morning before you donate blood.
• Avoid donating blood on an empty stomach. Eat three hours before you donate blood. Avoid fatty foods. Eat food rich in iron such as whole grains, eggs, and beef, and spinach, leafy vegetables, orange and citrus.
• Don’t consume alcohol or caffeine beverages before donating blood.
• Avoid donating blood for 6 months if you had any major surgery.

WHO first-ever list of antibiotic-resistant “priority” pathogens

• A new study by researchers at Harvard University of all 48 million Americans aged 65 and older on Medicare found people were dying after just a single day of breathing air that met federal standards, but was somewhat dirty. The study was published Tuesday in JAMA. Environmental Protection Agency sets safety standards and if pollution is below that standard, everyone is safe but the same is not correct. There is no safe level of exposure to either pollutant.
• Decades of research, including a new study published December 26 in JAMA has failed to find substantial evidence that vitamins and supplements do any significant good.
• Delhi LG gave a nod to three big health schemes of the Delhi government – treatment for road and fire accident and acid attack victims, outsourcing of high-end diagnostic tests and surgeries. He has given a nod to the amendment in the Delhi Arogya Kosh (DAK), which would help pay for the free diagnostic tests and surgeries. LG, however, asked the government to maintain an income ceiling for the people who would be allowed to avail the benefits of the scheme “so that the resources of the government are used to help the poor and the needy and the poor are not crowded out by the well-to-do”. With recent cases of medical negligence and malpractices in private hospitals, the LG also urged the government to have a mechanism to penalize institutions in case of malpractice or even poor quality of services.
• Nabarangpur: A district consumer forum has ordered a doctor of the Christian Hospital here to pay a compensation of Rs 20 lakh for “deficiency of service and medical negligence”, which left a pregnant woman paralysed on the lower part of her body (paraplegia), seven years ago. Sabina, a Bachelor of Physiotherapy was administered anesthesia as many as seven times by Dr Nag on May 19, 2010 while performing cesarean delivery, even though the latter was not qualified as MD (Anesthetist) and did so after her repeated refusal.
• In a shocking case from Argentina, doctors accidentally tore off an infant’s head during a delivery. The incident occurred as they were trying to deliver a premature baby when the child got stuck inside.
• WHO published its first ever list of antibiotic-resistant "priority pathogens" – a catalogue of 12 families of bacteria that pose the greatest threat to human health. The WHO list is divided into three categories according to the urgency of need for new antibiotics: critical, high and medium priority. The most critical group of all includes multidrug resistant bacteria that pose a particular threat in hospitals, nursing homes, and among patients whose care requires devices such as ventilators and blood catheters. They include Acinetobacter, Pseudomonas and various Enterobacteriaceae (including Klebsiella, E. coli, Serratia, and Proteus). They can cause severe and often deadly infections such as bloodstream infections and pneumonia. These bacteria have become resistant to a large number of antibiotics, including carbapenems and third generation cephalosporins – the best available antibiotics for treating multi-drug resistant bacteria. The second and third tiers in the list – the high and medium priority categories – contain other increasingly drug-resistant bacteria that cause more common diseases such as gonorrhea and food poisoning caused by salmonella.
• Drugs banned in 2017: Fixed dose combinations of nimesulide + levocetirizine; fixed dose combinations of ofloxacin + ornidazole injection; fixed dose combinations of gemifloxacin + ambroxol; fixed dose combinations of glucosamine + ibuprofen and fixed dose combinations of etodolac + paracetamol.
• In a new essay publishing 28 December in the open access journal PLos Biology, Kristofer Wollein Waldetoft and Sam P. Brown of Georgia Institute of Technology propose that development of alternative therapies for mild infections could help slow the development and spread of antibiotic resistance, thereby preserving the drugs' effectiveness for use in severe infections.
• Do not routinely administer prophylactic antibiotics in low-risk laparoscopic procedures: The use of prophylactic antibiotics in women undergoing gynecologic surgery is often inconsistent with published guidelines. Although the appropriate use of antibiotic prophylaxis for hysterectomy is high, antibiotics are increasingly being administered to women who are less likely to receive benefit. The potential results are significant resource use and facilitation of antimicrobial resistance.
• Avoid the unaided removal of endometrial polyps without direct visualization when hysteroscopic guidance is available and can be safely performed: Endometrial polyps are a common gynecologic disease. Though conservative management may be appropriate in some patients, hysteroscopic polypectomy is the mainstay of treatment. Removal without the aid of direct visualization should be avoided due to its low sensitivity and negative predictive value of successful removal compared to hysteroscopy and guided biopsy.

Dr KK Aggarwal

Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Group

President Heart Care Foundation of India

Immediate Past National President IMA