Influenza A H1N1 (Swine flu) epidemic in Chennai city

The Swine flu

            The swine flu is caused by a virus Influenza Type A H1N1. It was identified that the infection came from Swine from Mexico as they are very close contact with them. The modes of transmission are through droplet and fomites. This has an incubation period of 1 – 7 days to develop symptoms. People spread the infection by cough or sneeze. The virus is a fragile virus and it gets killed as the droplets dried off.

            The symptoms include High fever, running nose, cough, shortness of breathing etc.

Management of epidemic

The Swine flu is caused by a H1N1 influenza virus posed a lot of challenges before the Public Health managers in the city.

Following activities are undertaken by the Corporation of Chennai

a.      Alleviating fear among the population particularly among schools.

b.      Educating the medical practitioners

c.      Provision of diagnostic facilities

d.      Provision of treatment facilities

e.      Prevention activities.

Alleviating fear among the population particularly among schools.

The age distribution of infected individuals showed that most of infection happened among the age group between 4 years and 16 years. Most of they study in schools. More over cluster of cases were diagnosed in some select schools. This caused concern among the school authorities. Hence the following activities are undertaken.

a.                           Guidelines for identifying and handling the children with suspected illness and managing them was sent to all the schools

b.                           All the school head masters, principles from corporation, private and government schools were sensitized about the infections. They were oriented to identifying suspected symptoms.

c.                           Posters and pamphlets were developed specific to this epidemic distribution to all those who attend the classes

d.                           Specific guidelines were read to all the students in the prayer meetings.

e.                           Daily press releases were given to reassure the people.

Help line

A separate Help line was opened by the Chennai Corporation (1913). Officers were posted round the clock to answer the queries from the people. Every day more than 300 calls were attended by the officers

Sensitization of the private practitioners

            Corporation of Chennai had called all the Medical Practitioners through news paper and invitations through the Sanitary Inspectors. The response to the call was dramatic. In a single day 860 doctors were sensitized about this flu infection. The telephone numbers for assistance were provided to them.

Provision of diagnostic services

Initially the testing was done only at National Institute of Communicable Disease at New delhi. The samples were sent to NICD and results were given after two days. After some times there was huge demand for testing for this flu infection and this necessitated to establish own diagnostic facilities. The King Institute was identified as testing laboratory as they have the RT PCR facility (Real Time Polymerase Chain Reaction). Over the period of time the government permitted 5 Private laboratories to test for H1N1 infection later it was expanded to 8.  In order to cope up to demand from government side The Chennai Corporation has established 6 sample collection centers in Chennai Corporation Area.

Provision of Treatment services

One of most important component was provision of Treatment Services. As of now only Oseltemivir is the drug of choice and it is being provided only by the Government through Regional Directorate of Health and Family Welfare. The Communicable Diseases Hospital was identified by the Government of India for treating the H1N1 infection. One ward was exclusively allotted for admitting the infected patients. Initially the number of beds allotted for the swine flu was 32 later it was expanded to 200 beds. All the patients who were identified as H1N1 positive were admitted and 5 day course of Oseltemivir was given. Later two more hospitals were identified to admit and treat this influenza.

Contact tracing

The disease spread through the droplets and fomites. Most of the droplets gets settled with in one meter of the index case.  Hence Close contacts of Each of the infected patients was traced to identify the  suspected symptomatic. This was a well coordinated activity among the staff of Public Health Department with support from Education department for schools.

Flow chart for contact tracing

 

            Once a patient is admitted in Communicable diseases hospital the address and the details of the cases are intimated to the respective Asst. Health Officers and Sanitary inspectors of the respective division if that patient  is residing within Chennai Corporation limits. If they belong to out side of the city the respective Deputy Directors of the Health services are informed to do contact tracing.

            A detailed epidemiological investigation is being conducted and all the contacts are being examined for suspected symptoms. If any one is found they are given antibiotics and samples are sent to laboratory. The specific treatment is given once the test result is positive for H1N1

 

Program Management.

            The program management team which consist of The DC(Health), The Health Officer and Addl. Health Officers was set up. This team reviewed all the reports and monitored the situation on daily basis. The epidemiological reports from the field team were analyzed and suitable instruction was given.