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Burden of H1N1 Influenza in India (2010-2017): Identifying Hotspots and Policy Directions
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A4948 - Burden of H1N1 Influenza in India (2010-2017): Identifying Hotspots and Policy Directions
Author Block: P. Chatterjee1, B. Seth2, T. Biswas3, K. Bera4; 1National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India, 2Internal Medicine, Boston University Medical Center, Boston, MA, United States, 3Pediatrics, Independant Researcher, Kolkata, India, 4Center for Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, United States.
Rationale
Influenza A (H1N1) put the world on alert after attaining pandemic status in June 2009. India, a recognized hotspot for emerging infectious diseases (EIDs), is also vulnerable. Here we analyze the reported cases and deaths from H1N1 in India to identify possible policy responses.
Methods
Cases and deaths resulting from H1N1 influenza are reported to the Integrated Disease Surveillance Program (IDSP) from the 37 states and union territories (S/UTs) through a network of laboratories. The reported data were used to identify hotspots. Each S/UT was given a population-adjusted rank for the recorded number of cases and deaths for every year; mean ranks for reported cases and deaths over the 8-year period were calculated. Higher counts were given lower ranks; tied ranks were resolved by taking their mean. Case fatality rates (CFRs) were also computed.
Results
Between 2010-2017 (October 30th), there were 114,667 cases and 8,543 deaths due to H1N1 reported from India, at an overall CFR of 7.5%. Maharashtra accounted for 21% of the cases (23,812) and 31% of deaths (2648). Delhi and Gujarat were ranked the highest based on the population-adjusted ranks for morbidity and mortality respectively. The five top-ranked states for reported cases (Delhi 3, Telengana 4.75, Gujarat 6.38, Karnataka 6.75 and Goa 7.38) accounted for 41% of all cases of H1N1 in India. The five states to report the most number of cases (Maharashtra, Gujarat, Rajasthan, Delhi, Karnataka) accounted for 68% of all H1N1 cases in India. The five top-ranked states for reported deaths (Gujarat 3.75, Rajasthan 4.75, Maharashtra 5.75, Punjab 8, Kerala 9.75) accounted for 71% of all deaths from H1N1 in India.
The four states that reported the highest numbers of deaths also recorded a higher-than-national average CFR (Maharashtra: 11.1%; Gujarat: 9.1%; Rajasthan: 8.9%; Madhya Pradesh: 17.7%). In this eight-year period, Lakshadweep and Sikkim reported no cases. In fact, the eight states of North East India (Arunachal Pradesh, Assam, Nagaland, Mizoram, Meghalaya, Tripura, Manipur and Sikkim) accounted for only 326 cases (0.3%) and 15 deaths (0.2%), with a majority being reported from Assam (234 cases and 10 deaths).
Conclusions
Although the reported numbers likely underestimate the problem, there are hotspots vulnerable to H1N1.The high CFRs indicate gaps in initiating appropriate and timely therapy. Vaccination in susceptible populations, which is currently absent from the national immunization programs, needs to be explored as a potential public health response. Strengthening of surveillance remains a priority.
Author Block: P. Chatterjee1, B. Seth2, T. Biswas3, K. Bera4; 1National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India, 2Internal Medicine, Boston University Medical Center, Boston, MA, United States, 3Pediatrics, Independant Researcher, Kolkata, India, 4Center for Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, United States.
Rationale
Influenza A (H1N1) put the world on alert after attaining pandemic status in June 2009. India, a recognized hotspot for emerging infectious diseases (EIDs), is also vulnerable. Here we analyze the reported cases and deaths from H1N1 in India to identify possible policy responses.
Methods
Cases and deaths resulting from H1N1 influenza are reported to the Integrated Disease Surveillance Program (IDSP) from the 37 states and union territories (S/UTs) through a network of laboratories. The reported data were used to identify hotspots. Each S/UT was given a population-adjusted rank for the recorded number of cases and deaths for every year; mean ranks for reported cases and deaths over the 8-year period were calculated. Higher counts were given lower ranks; tied ranks were resolved by taking their mean. Case fatality rates (CFRs) were also computed.
Results
Between 2010-2017 (October 30th), there were 114,667 cases and 8,543 deaths due to H1N1 reported from India, at an overall CFR of 7.5%. Maharashtra accounted for 21% of the cases (23,812) and 31% of deaths (2648). Delhi and Gujarat were ranked the highest based on the population-adjusted ranks for morbidity and mortality respectively. The five top-ranked states for reported cases (Delhi 3, Telengana 4.75, Gujarat 6.38, Karnataka 6.75 and Goa 7.38) accounted for 41% of all cases of H1N1 in India. The five states to report the most number of cases (Maharashtra, Gujarat, Rajasthan, Delhi, Karnataka) accounted for 68% of all H1N1 cases in India. The five top-ranked states for reported deaths (Gujarat 3.75, Rajasthan 4.75, Maharashtra 5.75, Punjab 8, Kerala 9.75) accounted for 71% of all deaths from H1N1 in India.
The four states that reported the highest numbers of deaths also recorded a higher-than-national average CFR (Maharashtra: 11.1%; Gujarat: 9.1%; Rajasthan: 8.9%; Madhya Pradesh: 17.7%). In this eight-year period, Lakshadweep and Sikkim reported no cases. In fact, the eight states of North East India (Arunachal Pradesh, Assam, Nagaland, Mizoram, Meghalaya, Tripura, Manipur and Sikkim) accounted for only 326 cases (0.3%) and 15 deaths (0.2%), with a majority being reported from Assam (234 cases and 10 deaths).
Conclusions
Although the reported numbers likely underestimate the problem, there are hotspots vulnerable to H1N1.The high CFRs indicate gaps in initiating appropriate and timely therapy. Vaccination in susceptible populations, which is currently absent from the national immunization programs, needs to be explored as a potential public health response. Strengthening of surveillance remains a priority.
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