Government of India Ministry of health and Family Welfare Influenza A [H1N1] 4 August, 2009

Status as on: Dated 4th August, 2009

As on 27th July 2009 World health Organization has reported 134503 laboratory confirmed cases of influenza A/H1N1 and 816 deaths. There is no further update.

Health screening of passengers coming from affected countries is continuing in 22 International airports. 49353 passengers have been screened on 3.8.2009 of which 39,362 passengers were from affected countries. 224 doctors and 151 paramedics are manning 81 counters at these airports. A cumulative total of 43,00,939 passengers have been screened.

Sixteen laboratory confirmed cases have been reported today: Delhi (3), Pune (6), Mumbai (2), Chennai (2) Trivandrum (1) and Gurgaon (2).

The three cases in Delhi are (i) 22 year old male who travelled from Hong Kong to Delhi transiting Singapore and Kuala Lumpur by Air India AI 311 on 31st of July. He reported to the hospital with symptoms of fever and sore throat on 3rd August, 2007. (ii) the second case is an 18 year old male who travelled from Singapore to New Delhi by Cathay Pacific flight CX 751 reaching Delhi on the 2nd of August. He was isolated at the airport with influenza like illness. (iii) The 3rd case is a 25 year old male, who traveled by KLM Flight 692 from Toronto transiting Amsterdam and reaching Delhi on the 26th of July. He reported to the identified hospital with symptoms of sore throat and fever on the 3rd of August.

Of the six cases reported in Pune three are school children ( 14 year male, 11 year male, 14 year old female) who are contacts of positive cases reported earlier. Another indigenous case is a 20 year old male, indigenous case who were in contact with foreign nationals who visited Pune. The remaining two have travel history.
These cases are:

1. 27 year old male who has traveled from Houston USA to Mumbai by flight BA 197/137 transiting London, reaching Mumbai on 29th July and further travelling to Pune by car. He reported to the identified health facility with symptoms of cough, sore throat and fever on 4th August morning.
2. The second case is a 16 year old male, who travelled from Singapore to Mumbai reaching Mumbai on 31st July by Qantas airline QA 51 and further travelling to Pune by car. Patient complained of fever and running nose since 2nd August and admitted to identified hospitals on 3rd August.

The two cases in Mumbai are:

1. 10 year old female travelled from USA to Mumbai by flight British Airways flight BA 139 reaching Mumbai on 1st of August. She reported to the identified health facility with symptoms of fever and cough on 2nd August.
2. 28 year old female travelled from Bangkok to Mumbai by Thai Airways flight TG 317 reaching Mumbai on the 31st of July . she reported with symptoms of fever and cough to the identified health facility on 1st August.

The two cases from Chennai are

1. A five year old female who travelled from London to Chennai transiting Mumbai by Air India flight AI 144 reaching Chennai on 2st August. This case was detected at the airport screening and isolated to the identified health facility.
2. Two and half year old female who travelled from Kuala Lumpur to Chennai by Jet Airways flight no. 9W 031 reaching Chennai on the second. This case was also isolated at the airport with flu like symptoms.

The lone case reported from Trivandrum is a 39 year old male who travelled from UAE to Trivandrum by Qatar Airways QR 240 reaching Trivandrum on 28th July. He reported to the identified health facility with symptoms of cough and sore throat on the 3rd of August.

The two cases reported from Gurgaon are 41year old female and her eight old girl, who travelled from USA to New Delhi by KLM 871 transiting Amsterdam reaching Delhi on 24th July. Both of them reported to the health facility on 2nd of August with symptoms of Sore throat and cough. Another daughter who had travelled with them had earlier tested positive.

All the contacts of the girl child who expired yesterday at Pune are healthy and remain asymptomatic.

2528 persons have been tested so far out of which 574 are positive for Influenza A H1N1 [Swine]. 581 out of the 2528 persons have been identified through entry screening 549 through contact tracing and the rest were self reported.

Of the 574 positive cases, 470 have been discharged. One case has died. Rest of them remains admitted to the identified health facility.

The state-wise break up of cases is annexed.

The present guidelines stipulate that a person suspected of influenza A H1N1 need to be referred to an identified govt. health facility. He/she needs to be kept in an isolation facility in that hospital and if found positive, is treated accordingly. In order to make the testing facility for H1N1 more accessible at large and due to the onset of the Influenza season in the country, it has been decided to revise the existing guidelines. Under the new guidelines, any person with flu like symptoms such as fever, cough, sore throat, cold, running nose etc. should go to a designated Government facility for giving his/her sample for testing for the H1N1 virus. After clinical assessment, the designated medical officer would decide on the need for testing. Except for cases that are severe, the patient would be allowed to go home (This was not allowed under the existing guidelines). The detailed guidelines is annexed to this report.

The situation is being monitored.

Revised Guidelines for Testing of Persons with Flu Like Symptoms Reporting at Hospitals Notified for Influenza H1N1

So far, the present guidelines stipulate that a person suspected of influenza A H1N1 need to be referred to an identified govt. health facility. He/she needs to be kept in an isolation facility in that hospital and if found positive, is treated accordingly. In order to make the testing facility for H1N1 more accessible at large and due to the onset of the Influenza season in the country, it has been decided to revise the existing guidelines.

Under the new guidelines, any person with flu like symptoms such as fever, cough, sore throat, cold, running nose etc. should go to a designated Government facility for giving his/her sample for testing for the H1N1 virus. After clinical assessment, the designated medical officer would decide on the need for testing. Except for cases that are severe, the patient would be allowed to go home (This was not allowed under the existing guidelines).

The sample of the suspect case would be collected and sent to the notified laboratory for testing. If tested as positive for H1N1 and in case the symptoms are mild, the patient would be informed and given the option of admission into the hospital or isolation and treatment at his own home.

In case the patient opts for home isolation and treatment, he/she would be provided with detailed guidelines / safety measures to be strictly adhered to by the entire household of the patient. He/she would have to provide full contact details of his entire household. The house hold and social contacts would be provided with the preventive treatment.

Notwithstanding the above guidelines, the decision of the doctor of the notified hospital about admitting the patient would be final.

In case the test is negative, the patient will accordingly be informed.

These guidelines have been issued by the Government in public interest and shall be reviewed from time to time depending on the spread of the pandemic and its severity in the country. These guidelines would however not apply to passengers who are identified through screening at the points of entry. The existing policy of isolating passengers with flu like symptoms would continue.

State-wise and City-wise break up of laboratory confirmed cases.

S. No	State	City	No of Cases
Imported Cases (366)
1	Karnataka	Bangalore	42
2	Tamil Naidu	Chennai	29
		Coimbatore	2
		Madurai	1
3	Delhi	Delhi	109
4	Punjab	Fatehgarh	1
		Jalandhar	13
		Gurdaspur	2
		Hoshiarpur	1
		Amritsar	3
		Roopnagar	1
		Patiala	2
5	Andhra Pradesh	Hyderabad	45
		Vishkhapatnam	1
6	Maharashtra	Mumbai	22
		Pune	20
7	Goa	Panjim	6
8	Haryana	Gurgaon	10
9	West Bengal	Kolkata	5
10	Kerala	Calicut	14
		Cochin	14
		Trivandrum	10
11	Gujarat	Kandla	1
		Ahmedabad	3
12	Jammu & Kashmir	Srinagar	2
13	Uttarakhand	Dehradun	2
		Roorkee	1
14	Chandigarh (UT)		3
15	Manipur	Imphal	1
Indigenous Cases (208)
1	Delhi	Delhi	54
2	Andhra Pradesh	Hyderabad	16
		Vishakhapatnam	3
3	Punjab	Gurdaspur	1
4	Haryana	Gurgaon	9
5	Karnataka	Bangalore	7
6	Maharashtra	Pune	92
		Mumbai	1
7	Gujarat	Ahmedabad	1
8	Kerala	Trivandrum	6
		Cochin	2
		Calicut	3
9	Rajasthan	Jaipur	4
10	Tamil Nadu	Chennai	2
		Coimbatore	1
11	Goa	Panjim	1
12	Uttarakhand	Dehradun	1
13	Chandigarh (UT)		1