India Swine Flu 2015: Death Toll Tops 1,000 In More Than 20,000 Cases!!!!

India’s Health Ministry said Monday 1,115 of the 20,795 people infected with swine flu in 2015 have died. Officials said the virus usually increases during a monsoon, but they could not say whether the recent heavy rainfall in Delhi and other parts of the country's north would have any impact on the current H1N1 virus pandemic, the Times of India reported. They have, however, said they were not expecting a decrease in the incidence of the virus due to the rain.

The state of Gujarat has the highest death toll, with 275 dead from the disease, the Times of India said. That is followed by Rajasthan with 267 deaths and Madhya Pradesh with 160 deaths. Rajasthan has the highest number of confirmed cases, with 5,610, followed by Gujarat with 4,614 cases and Delhi with 2,999 cases.

Maharashtra state Chief Minister Devendra Fadnavis announced his state will treat all swine flu patients free of charge, the Times of India reported. "I have issued instructions to the public health department to ensure completely free treatment of H1N1 patients in private hospitals across the state,” he told the newspaper. “They cannot refuse swine flu treatment to anyone and the government will bear the entire cost of such treatment." Of the 1,789 cases reported in Maharashtra, 152 resulted in death.

Rajasthan Health Minister Rajendra Singh Rathore announced during a state assembly all government hospitals would provide free face masks to patients who test positive for the H1N1 virus, India news site NDTV reported. He also shot down questions suggesting there had been negligence by medical staff at government hospitals. Rajasthan declared a swine flu epidemic earlier in February.

India experienced a similar H1N1 pandemic in 2009 and the pandemic this year has been India’s worst resurgence since. More than 2,700 died from May 2009 to December 2010, Reuters reported.

The severest flu cases are in young, unvaccinated adults!!!! ( Its time to get vaccinated)

A snapshot of patients who required care at Duke University Hospital during this year's flu season shows that those who had not been vaccinated had severe cases and needed the most intensive treatment.

In an analysis of the first 55 patients treated for flu at the academic medical center from November 2013 through Jan. 8, 2014, Duke Medicine researchers found that only two of the 22 patients who required intensive care had been vaccinated prior to getting sick.

The findings were published online in the American Journal of Respiratory and Critical Care Medicine.

"Our observations are important because they reinforce a growing body of evidence that the influenza vaccine provides protection from severe illness requiring hospitalizations," said lead author Cameron Wolfe, M.D., assistant professor of medicine at Duke. "The public health implications are important, because not only could a potentially deadly infection be avoided with a $30 shot, but costly hospitalizations could also be reduced."

Wolfe said this year's flu season was marked by hospitalizations of previously healthy young people, with a median age of 28.5 years. Among those who were hospitalized at Duke, 48 of the 55 were infected with the H1N1 virus that caused the 2009 pandemic. That outbreak also hit young adults particularly hard.

"We observed a high percentage of hospitalized patients for influenza requiring ICU level care, which appears higher than observed in our hospital during the 2009 pandemic flu season," said co-author John W. Hollingsworth, M.D., associate professor of medicine at Duke. "It remains unclear whether the high rate of ICU admissions represents a diagnosis bias or whether the severity of illness being caused by the current H1N1 virus is higher."

Of the 33 patients admitted to regular wards rather than the ICU at Duke University Hospital, only eleven had been vaccinated; most of those were immune compromised, chronically ill, or were on a medication that weakened the vaccine's protection.

The study also echoes other studies that have highlighted problems with a rapid test for influenza.

Wolfe said 22 of the patients treated at Duke University Hospital had been given a rapid influenza test that came up negative for flu, but they were actually positive when tested by other methods. As a result, they had not received anti-viral medications that might have eased flu symptoms had they been taken early.

"Together, our observations during this influenza season support a high prevalence of the H1N1 virus affecting young adults and requiring ICU care, high false negative rates of rapid flu tests, and delay in starting antiviral treatment," Wolfe said. "Added to the finding of very low vaccination rates among both hospitalized and ICU admissions, our observations support previous findings that vaccination reduces the severity of disease and vaccinations should be encouraged as recommended by the U.S. Centers for Disease Control and Prevention."

Outbreak of swine flu in India is no worse than seasonal flu, say specialists- British Medical Journal News.

The outbreak of H1N1 influenza in India this year, which has killed 875 people since 1 January, is not yet a major concern because the incidence and mortality are no different from those caused by seasonal flu in developed countriessuch asthe United States, infectious disease specialists have told The BMJ.

                However, they said the Indian government should now recommend vaccination for at-risk groups including elderly people, patients with chronic diseases, pregnant women, and young children.          
                India does not currently recommend yearly influenza vaccinationsfor the general public because the burden of H1N1 is so small when compared with diseases such as tuberculosis, which affected 2.1 million people in 2013.1 Such a vaccination becomes ineffective after a year and takes 3-4 weeks to confer immunity—making its large scale use impractical, said Jagat Prakash Nadda, India’s health minister, in written responses to questions raised in the upper and lower houses of the Indian parliament this week. However,since the H1N1 outbreak began last year the health ministry has recommended a vaccine for public health workers who come into contact with infectious patients.

                   The H1N1 epidemic has affected 15 413 people since the start of 2015, compared with 27 236 in 2009 and 20 604 in 2010. The death tolls in 2009 and 2010 were 981 and 1763, respectively. This year the most affected state has been Rajasthan, with 4734 confirmed cases, followed by Gujarat, with 3337 cases.

             Rising mortality has led to panic among the public and an increased demand for diagnostic tests and treatment, even among people with no flu symptoms. This has put extra pressure on the limited infrastructure available for swine flu testing in India. Currently, only 46 government laboratories across the country can test for swine flu, in addition to accredited private labs. And demand for more tests has led to overcharging by private labs, some of which have charged Rs 3000 to Rs 9000 (£31 to £94; €43 to €128; $49 to $146) for a test.

             The Indian government’s response has been to ask the drug controller to ensure the availability of the antiviral drug oseltamivir (Tamiflu) in all stores that have a licence to stock it, as well as regulating prices of swine flu diagnostic tests, which have risen since the outbreak began. The worst affected states,such as Gujarat, have taken stronger measures: yesterday the Gujarat government banned public gatherings from taking place without permission, in an attempt to stem the spread of the disease.

                   The strain of H1N1 circulating this year is the same as that in 2009, the health ministry said. George M Varghese, professor of medicine and infectious diseases at the Christian Medical College in Vellore, Tamil Nadu, said that the resurgence of the disease could be because people who acquired immunity in the 2009 epidemic have now lost the antibodies, making this a natural spike in the disease cycle. Nevertheless, the epidemic is expected to die down in a month or two as temperatures rise and conditions become unfavourable for the virus to transmit itself, doctors told The BMJ.

                      While the mortality rate of 5.6% (875 of 15 413 cases) seems high and has raised concern among the general public, it does not indicate the virulence of the disease, said the doctors: the actual number of affected people is likely to be far higher than 15 413 because only severe cases and deaths are reported. The mortality rate from H1N1 istherefore probably lower than 0.5% and closer to the mortality from seasonal flu in developed countries such as the US.

                H1N1 tends to cause complications only in people with pre-existing conditions. Dilip Mathai, dean of the Apollo Institute of Medical Sciences and Research in Hyderabad, said that vulnerable groups of people, such as pregnant women, elderly people, and public healthcare workers, should therefore use facial masks and be vaccinated.
             Most doctors The BMJ spoke to said that the government’s response to the current epidemic was adequate, but a few experts argued that India is lagging behind in epidemiological and genomic research into H1N1 outbreaks, which is critical in anticipating future epidemics and vaccines’ effectiveness.

                Thekkekara Jacob John, clinical virologist and formerly a professor at the Christian Medical College, said that India was not tracking the prevailing strains of flu or the climatic and social conditions that can trigger an outbreak. The lack of a public health ministry in India, he said, means that India is missing out on valuable early stage data during an epidemic, which can curtail its spread.

                    He said, “A public health department would have kept track of which virus is beginning to show up as seasonal flu. If it was H1N1, an immediate response should have been instituted a few months ago.” Another gap in India’s response has been the lack of data on the swine flu viral genome. India has contributed surprisingly little to global databases on the influenza genome even though it sees frequent large outbreaks, said Ram Sasisekharan, professor of biological engineering at the MassachusettsInstitute of Technology, USA. This means that India may be unaware of mutations happening in different regions of the country, he said, which may render vaccines ineffective against the disease.

Flu infections can lead to deadly cytokine storm that sparks lung inflammation

Scientists at The Scripps Research Institute (TSRI) have mapped key elements of a severe immune overreaction - a "cytokine storm" - that can both sicken and kill patients who are infected with certain strains of flu virus.

Their findings, published in the online Early Edition of the Proceedings of the National Academy of Sciences, also clarify the workings of a potent new class of anti-inflammatory compounds that prevent this immune overreaction in animal models.

"We show that with this type of drug, we can quiet the storm enough to interfere with the virus-induced disease and lung injury, while still allowing the infected host to mount a sufficient immune response to eliminate the virus," said John R. Teijaro, an assistant professor in TSRI's Department of Immunology and Microbial Science and first author of the study.

"This study provides insights into mechanisms that are chemically tractable and can modulate these cytokine storms," said Hugh Rosen, professor in TSRI's Department of Chemical Physiology and senior author of the study with Michael B. A. Oldstone, professor in TSRI's Department of Immunology and Microbial Science.

Calming the Storm

A cytokine storm is an overproduction of immune cells and their activating compounds (cytokines), which, in a flu infection, is often associated with a surge of activated immune cells into the lungs. The resulting lung inflammationand fluid buildup can lead to respiratory distress and can be contaminated by a secondary bacterial pneumonia - often enhancing the mortality in patients.

This little-understood phenomenon is thought to occur in at least several types of infections and autoimmune conditions, but it appears to be particularly relevant in outbreaks of new flu variants. Cytokine storm is now seen as a likely major cause of mortality in the 1918-20 "Spanish flu" - which killed more than 50 million people worldwide - and the H1N1 "swine flu" and H5N1 "bird flu" of recent years. In these epidemics, the patients most likely to die were relatively young adults with apparently strong immune reactions to the infection - whereas ordinary seasonal flu epidemics disproportionately affect the very young and the elderly.

For the past eight years, Rosen's and Oldstone's laboratories have collaborated in analyzing the cytokine storm and finding treatments for it. In 2011, led by Teijaro, who was then a research associate in the Oldstone Lab, the TSRI team identified endothelial cells lining blood vessels in the lungs as the central orchestrators of the cytokine storm and immune cell infiltration during H1N1 flu infection.

In a separate study, the TSRI researchers found that they could quiet this harmful reaction in flu-infected mice and ferrets by using a candidate drug compound to activate immune-damping receptors (S1P1 receptors) on the same endothelial cells. This prevented most of the usual mortality from H1N1 infection - and did so much more effectively than the existing antiviral drug oseltamivir, although the combination of both therapies worked even better. "That was really the first demonstration that inhibiting the cytokine storm is protective," said Teijaro.

Mapping a Path Forward

For the new study, Teijaro and his colleagues set out to map the major elements of the cytokine storm in H1N1 infection. To do so, they used gene knock-out techniques to breed mice that lack one or more molecular sensors ofinfluenza virus infection and then observed the response to infection by H1N1 influenza virus.

The experiments showed that knocking out any one infection-sensing pathway has relatively modest effects on damping the cytokine and immune cell lung-infiltration response. In each case, an experimental drug compound (CYM5442) that activates S1P1 receptors knocked it down much more.

"What this shows is that our drug is working not through one selective pathway but much more broadly," said Teijaro. "Many different cytokines are induced in this reaction, so just blocking one is surely not enough to reduce the lung disease."

While CYM5442's effect is broad, its action is selective on cells that bear the sphingosine-1-phosphate 1 receptor (S1P1R). Teijaro pointed out that it is also milder than those of steroids, which act indiscriminately on all lymphoid cells, and other strong immunosuppressant drugs, which may block the immune response so completely that an infecting virus ends up replicating out of control.

An optimized version of CYM5442, initially developed by Rosen and fellow TSRI chemist Ed Roberts, has been licensed to the pharmaceutical company Receptos. It is now in Phase 3 clinical trials for treating relapsing-remitting multiple sclerosis and Phase 2 trials for ulcerative colitis. Other S1P1 receptor agonists are in development for inflammatory conditions. A less-specific S1P receptor agonist - which hits S1P1, but also hits S1P3, S1P4 and S1P5, with potential off-target effects - is already approved for treating multiple sclerosis.

"We'd like to understand all the pathways through which S1P1 agonists work and, by pinpointing specific stop/start points, figure out how best to target those pathways with future drugs," said Teijaro, who plans further studies with his colleagues to determine what other cell types are involved in orchestrating and possibly quieting the cytokine storm. "I'm hoping our work can further contribute to TSRI's long track record of success in employing small molecule probes coupled to genetic and biochemical tools to provide biological insight into pathological disease processes."