Kumar Surendra
SP Medical College & AG Hospital, Bikaner, Rajasthan.
J Assoc Physicians India. 2016 Jul;64(7):46-49.
The outbreak of H1N1 virus had previously reported in India during 2009 flu pandemic. In 2015, the outbreak became widespread throughout India. The states of Gujarat and Rajasthan are severely elected. We studied an outbreak of H1N1 Virus in north-west zone of Rajasthan 2015.
To demonstrate the current epidemiological scenario of swine flu (H1N1) in north-west zone of Rajasthan with different demographic factors.
We screened total 6390 patients. Out of them 1405 samples of suspected cases collected from different parts of north-west Rajasthan and analyzed by RT-PCR at Sardar Patel Medical College, Bikaner.
A total of 1405 samples examined during three and half months period, out of which 181 cases found positive for H1N1. Out of them 85 (46.97%) males and 96 (53.03%) females (M:F=1:1.13). Most patients (116) were in age group 21-50 years which was 64.09% of total positive cases (Mean age=37.09 ± 16.07years). The mean time of onset of symptoms to hospitalization was 5.12 ± 3.38 days. Only 11.05% patients presented within 48 hours whereas 64.09% presented between 3-5 days of onset of symptoms. 109 (60.22%) patients were from rural areas, whereas 72 (39.77%) belonged to urban areas. Total 13 (7.18%) deaths occurred among positive cases. 69.23% deaths were recorded in the age group of 25 to 50 years. The mean age of death being 44.69 years. Females had significant higher mortality (9 females out of 13 deaths). 76.92% died within 3 days of hospitalization, despite of starting Oseltamivir in a dose of 150 mg/bd on the day of admission. 84.61% of the patients who died had one or more risk factors. Bilateral pneumonia was observed in all the 13 patients and MODS in 2 patients.
With the above observation of swine flu trend it is likely that incidence is more in young to middle age group, majority of them having no risk factors, should form the target of future studies. However fatality is highest in patients with co-morbid condition or predisposing risk factors need to vaccinate this group should form a basis on which future directions and interventions have to be built up to reduce the morbidity and mortality. Females have slightly increased susceptibility for infection M:F=1:1.13). but mortality is much higher in this sex group. More patients belong to rural areas reflecting the need of creating public awareness especially in rural areas at primary health centre level and where illiteracy is common and crowded urban areas to present early at screening centres, so future outbreak can be prevent. The in-hospital mortality of 7.18% despite of starting Oseltamivir has raised concern about identifying the so called "Rapid Progressors" [76.92% died within 3 days of hospitalization]. Despite of all mortality is less in north-west zone as compared to rest of Rajasthan.
2009年流感大流行期间，印度曾报告过甲型H1N1流感病毒疫情。2015年，疫情在印度全境蔓延。古吉拉特邦和拉贾斯坦邦受灾严重。我们研究了2015年拉贾斯坦邦西北部地区的甲型H1N1流感病毒疫情。
通过不同人口统计学因素，展示拉贾斯坦邦西北部地区猪流感（H1N1）的当前流行病学情况。
我们共筛查了6390名患者。其中，从拉贾斯坦邦西北部不同地区采集了1405份疑似病例样本，并在比卡内尔的萨达尔·帕特尔医学院通过逆转录聚合酶链反应（RT-PCR）进行分析。
在三个半月的时间里共检测了1405份样本，其中181例甲型H1N1呈阳性。其中男性85例（46.97%），女性96例（53.03%）（男：女=1：1.13）。大多数患者（116例）年龄在21至50岁之间，占总阳性病例的64.09%（平均年龄=37.09±16.07岁）。症状出现到住院的平均时间为5.12±3.38天。只有11.05%的患者在48小时内就诊，而64.09%的患者在症状出现后的3至5天内就诊。109例（60.22%）患者来自农村地区，72例（39.77%）来自城市地区。阳性病例中共有13例（7.18%）死亡。69.23%的死亡病例年龄在25至50岁之间。平均死亡年龄为44.69岁。女性死亡率显著更高（13例死亡中有9例为女性）。尽管在入院当天就开始使用150毫克/每日两次剂量的奥司他韦进行治疗，但76.92%的患者在住院3天内死亡。84.61%的死亡患者有一个或多个危险因素。13例患者均出现双侧肺炎，2例出现多器官功能障碍综合征（MODS）。
根据上述对猪流感趋势的观察，很可能在青年到中年人群中发病率更高，他们中的大多数没有危险因素，应成为未来研究的对象。然而，合并症或易感危险因素患者的死亡率最高，需要对这一群体进行疫苗接种，这应成为制定未来方向和干预措施以降低发病率和死亡率的基础。女性对感染的易感性略有增加（男：女=1：1.13），但这一性别群体的死亡率要高得多。更多患者来自农村地区，这反映出有必要提高公众意识，特别是在基层卫生中心层面的农村地区，以及在文盲现象普遍且拥挤的城市地区，以便人们能尽早到筛查中心就诊，从而预防未来的疫情爆发。尽管开始使用了奥司他韦，但住院死亡率为7.18%，这引发了对识别所谓“快速进展者”的关注（76.92%的患者在住院3天内死亡）。尽管如此，与拉贾斯坦邦其他地区相比，西北部地区的死亡率较低。
