This document discusses the H1N1 influenza outbreak in India in 2009. It reports that the first case was detected in May 2009 in a person who had traveled from an affected country. Major outbreaks occurred in the states of Maharashtra, Karnataka, and Tamil Nadu. The virus was a new subtype of influenza A that contained gene segments from human, avian, and swine influenza viruses. Transmission occurred via droplets or contaminated surfaces. Symptoms included fever, cough, and respiratory issues. Treatment involved antiviral medication and supportive care. Infection control measures like isolation, PPE, and early treatment were recommended to prevent severe illness and death.

1. DR.S.M.JOSHI
Sr.MEDICAL OFFICER,
GOVT.Of MAHARSTRA

2.  Influenza like illness by Influenza H1N1 a
reassorted virus was reported from Mexico
on 18th March 2009 .and later spread to
united states and Canada from year 2009.and
subsequently spread to all the continents. In
India first case reported on 13th May
2008.due to travel from affected countries.
Substantial no. Of cases were found in
Maharashtra(Mumbai,and Pune),
Karnataka(Bangluru),Tamilnadu(Chhenai)are
indigenous cases. Majority cases of death
were due to some underlying diseases or
reported late to healthcare facility.

3.  Agent:-New subtype of Influenza A H1N1 virus
with segments from 4 influenza viruses. North
American swine, viruses. North American avian,
Human infuenza,Urassian Swine.
 Host:-Majority in healthy young adults
 Transmission:- by droplet infection and fomites.
 Incubation Period:-1-7 days.
 Communicability:-1 day before and 7 days after
the onset of symtoms and if illness persist >7
days then till resolution of illness .children may
spread the virus for longer period.

4.  Fever, upper respiratory symtoms,i.e.cough,
running nose sore throat,headache,bodyache,
fatigue,diarrhea,and vomiting.
Possible complications:-Sinusitis,Otitis Media,
croup,Pneumonia,Bronchiolitis,status
asthmaticus
,Myocarditis,pericarditis,myositis,enchephelitis
,Seizures,Toxic shock syndrome and
secondary bacterial Pneumonia with or
without sepsis

5.  Routineinvestigations`like
 Heamatology,Biochemistry,Radiology,Microbiolog
y tests are required.
 For Confirmation of diagnosis:-
 Real time PCR,Isolation of Virus culture, Four
fold rise in virus specific neutralising antibodies.
Are required.
 Clinical specimens of nasopharyngeal swab,
nasal swab, wash or aspirate,treacheal aspirate
are to be obtained samples should be collected
before giving antiviral drug. At 4 ⃰ C in viral
transport medium to designated lab within 24
hours. if not possible then kept store under -70 ⃰
C.Paired blood samples at an interval of 14 days
for sero.testing also to be collected.

6.  Suspect case:- a person with acute febrile
respiratory illness (fever ≥38*C) within 7 days
contact with a person who is confirmed case .or
within 7 days contact with a person where there is one or
more is confirmed cases. or resides in a community where
one or more confirmed cases.
 Probable case:- a person with acute febrile respiratory
illness is positive for influenza A but not to H1.H3 by
RTPCR.
 Is positive for influenza rapid test, or immunofloroscent
assay. And meets the criteria of suspect case.
 Individual with clinically compatible illness died due
to unexplained acute respiratory illness and
epidemiologically linked with probable or confirmed
case.

7.  Confirmed case:- :- a person with acute
febrile respiratory illness (fever ≥38*C) with
lab. Confirmed pandemic influenza virus A at
WHO approved Lab. By one or following
tests.
 Real time PCR
 Viral Culture
 Four fold rise in virus specific neutralising
antibodies.

8. Implementation of infection control
precautions, prompt treatment to prevent
severe illness and death, early identification
and follow up of persons at risk.
1. Isolation.
2. Dedicated Doctors, Nurses, Paramedical
workers
Portable X-ray machine ventilators ,oxygen
cylinders, pulse ox meters.
3 Adequate quantities of PPE,disinfectants,and
medications ( oseltamivir, and other
medications)

9. A. Reinforce standard infection control
precautions
B. Restrict no. Of visitors and provide them
PPE
C. Provide antiviral prophylaxis to health
care personnel .
D. Dispose waste properly by placing it in
sealed impermeable bage labelled as Bio
Hazard.

10.  Dose for treatment as follows.
By weight:-
For weight <15 kg = 30mgBD for 5 days
15-23kg = 45mgBD for 5 days
224< 40kg = 60mgBD for 5 days
>40kg = 75mgBD for 5 days
For infants:-
<3 months = 12 mg BD for 5days
3 -5months = 20mg BD for 5days
6-11 months = 25mg BD for 5days
If needed dose and duration can be modified as per
clinical condition.

11.  Transient nausea, vomiting in increasing doses
 ,occasionally it may cause bronchitis, insomnia,
vertigo
 .less commonly angina,pseudomembranous
colitis,peritonsilar abscess
 ,anaphylaxis and skin rashes.

12.  IV fluids
 Parenteral nutrition.
 Oxygen therapy.
 Antibiotics for secondary infection
 Vasopressors for shock.
 Paracetamol for fever.
 Plenty of fluids orally.
 Abstain from smoking
 Topical decongestants, nasal drops, lozenges,
steam inhalation.

13.  PPE reduces the risk of infection if used
correctly.
 It includes:-
 Gloves.(nonsterile)
 Mask, high efficiency mask, three layered
surgical mask,
 Long sleeved cuffed gown,
 Protective eyewear(goggles.visors,face
shields)
 Cap
 Plastic apron.