SWINE FLU IN INDIA & WORLD

The WHO has raised the Influenza Pandemic Alert to the highest level which is 6. Already India has seen over 40 confirmed cases of Swine Flu and the threat of a full blown epidemic in India is very real. The best we citizens can do is keep ourselves informed about the happenings and the steps we can take to prevent the spread of the flu. With most of the affected people fitting the profile of a person with internet access, we believe the internet is the first place that people would come looking for information like symptoms, who to contact etc. Swine Flu India is an attempt to bring all the necessary information in one place. India cannot afford to fall sick. Keep yourself and others informed.


Total Confirmed Cases in India

1928**
Total Deaths in India

29***
Total Confirmed Cases Worldwide

177457*
Total Deaths Worldwide

1462*
Last Updated Date and Time

19/08/2009 11:30 IST
Sources :

http://mohfw.nic.in/press_releases_on_swine_flu.htm

SWINE FLU CASES IN INDIAN STATES

SWINE FLU IN INDIAN STATES-ANALYSIS

Influenza H1N1-List of State Nodal Officers and contact details of Control Room

Andhra Pradesh
Office of The Addl. Director (Health Services), Hyderabad Nodal Officer:Dr Ramswarup [09989923781]
Arunachal Pradesh
SSU IDSP, Directorate of Health Services, Naharlagun, Arunachal Pradesh. Tel: 0360-2245460Telefax: 0360-2244271Nodal Officer:Dr.L.Jampa [09436055743]

Assam
Office of the Director (Health Services), Guwahati.0361-2235577 0361-2261630Nodal Officer:Dr Doley, 0361-2642008, 09854066560

Bihar
Office of the Executive Director,State Health Society, Sheikhpura, Patna. 0612-2280562,0612-2281232,0612-2290322(F)Nodal Officers:Mr. Santosh Mathew (IAS)Dr D K Gupta (Addl.Nodal officer)- 09430057795Control Room In-charge (Dr BK Singh: 9470003023)

CHHATISHGARH
State Surveillance Unit (IDSP),Directorate Health services,Old Nurses Hostel, DKS Mantralya Campus,RaipurNodal Officers:Dr T K Agarwal (Deputy Director, Epidemic)-Nodal officer: 09926624162Dr S N M Murti (Addl.N.O), 09425564418

GUJARAT
Office of Dy.Director (Epid)Commisionerate of Health Services Block No:5,Dr.Jivaraj Mehta Bhawan, Old Sachivalaya Ahmedabad, GujaratNodal Officer:Dr.S.J.Gandhi [09825342899]

GOA
Call Centre: 0832- 2458458Nodal Officer:Dr.Tamba (09822123801)

HIMACHAL PRADESH
IDSP Cell, Directorate of Health Services,Kasumti, Shimla-9Nodal Officer:Dr.Vinod Mehta(09418163500)

HARYANA
Office of the Director (Health Services),Sector-6, Panchkula0172-2587346[During office hours]Nodal Officer:Dr.Aparajita Sondh (Nodal Officer) 09417931024[24x7]

JAMMU-KASHMIR
Office of DHS, Srinagar, J& KTel/Fax. No (0194) 2452697 (main)Nodal Officers:Dr.M.Ahmed (09419012355), Dr.Bashir Ahmed Dar (Addl.N.O) (09419017716)

JHARKHAND
RIMS, RANCHIChamber of Dr. A. K. Mathur (HOD Medicine)Nodal Officers:Dr C.B Sharma (094311740820),Dr.Pradeep Baski

KERALA
Office of Addl.DHS (Public Health),Near Govt. General Hospital TrivandrumTF:(0471) 2466828[24X7]Nodal Officers:Dr. Amar (09447451846), DR. SHAUKAT ALI (Joint Director,NICD)-09447702444

KARNATAKA
Office of the Director (Health and Family Welfare),Anand Rao Circle, Bangalore-9Phone no: 080-1056 [24X7]Nodal Officers:Dr.Chelluraj-09901060584, Dr.Vasudev Murthi-09880024329

MAHARASHTRA
MumbaiRoom no.137,First Floor,Swasthaya Bhawan,Mumbai.022-22029070 ,022-22025830Nodal Officers:Dr. Gawande-09420711426,Dr Awate-09423337556PuneOffice of the Joint Director (Health Services),Central Building , Pune020-26124299 [24X7]Nodal Officers:Dr. Desai-09822429266, Dr. Suresh Bohatre-09881364656

MEGHALAYA
Office of DHS, Medical InstitutionsNokrek Bldg. 3rd Secretariat,Nodal Officer:Dr.R.R.Lanong,(09436102763)

MANIPUR
Medical Directorate, Office of DHS, ManipurRoom no-23, Lamphelpat Manipur-795004Nodal Officer:Dr Bhubon Chandra[09436021607]

MADHYA PRADESH
State Surveillance Unit, Directorate Health Services, Satpura Bhavan, Bhopal0755-4094192(TF)[Office hours only]Nodal Officer:Dr. B N Chauhan-09826282249

MIZORAM
Civil hospital,Aizwal0389-2322318Nodal Officer:Dr Sangawalar, 0389-2313721

NAGALAND
SSU IDSP, Directorate of Health Services& FW,T.R .Hill, KOHIMA-797001.Tel:(0370)2245016[Office hours only]Nodal Officer:Dr.Kebichusa(09436000463)[24x7]

ORISSA
State Surveillance Unit, Director of Health Services, Heads of the Department Buildings, Bhubaneshwar.0674-2390466 (TF)[24x7] Nodal Officer:Dr. V. Patnaik-0674-2390466

PUNJAB
Pariwar Kalyan Bhawan,Sector-34A, Chandigarh.Tel:(0172) 2621506Nodal Officer:Dr. Deepak Bhatia-09814302403 [24x7]0172-2621506(0)/0172-2620234(Fax)

RAJASTHAN
Office of the Director (Public Health), Swasthaya Bhawan, Jaipur.0141-2225624,0141-2224831(F) Nodal Officers:Mr. R K Meena ,IAS, Principal Sect.(Health)- Nodal OfficerDr. O P Gupta(Addl.Nodal Officer)-0141-2229858

SIKKIM
SSU IDSP, Health & F.W.Govt. of SikkimNodal Officer:Dr.Y.D.Chingappa(09832079576)

TRIPURA
DHS buildingPN BuildingNodal Officers:Dr P Chatterjee (09436120711),Dr.R.K. Dhar

TAMILNADU
Office of the Director (Public Health &Preventive Medicine),Central Malaria Laboratory,359,Annasalai,Chennai-6Nodal Officer:DR. Elango, DHS,(09940610123)

UTTARAKHAND
Office of DHS, IDSP,107,Chander Nagar, DehradunTF: 0135-2721792,0135-2729897Nodal Officer:Dr.Pankaj Jain(09412969502)[24x7]

UTTAR PRADESH
Swasthaya Bhawan,LuknowControl Room No-Tel:(0522)2616482Fax:(0522)2622819Nodal Officer:Dr Pyaremohan Srivastava,0522-2629106(TF)(09415181629)

WEST BENGAL
Chamber of Joint Director (Health Services), Swasthaya Bhawan,Sector-5,GN Block, Kolkata-91(033)-23571192Nodal Officer:Dr.Bhaskar Bhattacharya,033-23330180,(09831187818)

ANDAMAN AND NICOBAR
G.B.Pant Hospital, Port BlairTel:03192-230622,233473Dr.Abhijit Roy,Dy.Director(H)(09474269315),T/F: (03192-232797)

CHANDIGARH
Govt. Multispecialty Hospital,Sector-16, Chandigarh.Call Centre:102Nodal Officer:Mr. H.C. Gera (09988212139),(0172)-2740408

DADRA
Office of DHS, Silvassa.Nodal Officer:Dr.L.M.Patra DHS

DAMAN AND DIU
CHC, Daman.Tel:(0260)2230080Nodal Officer:Dr.B.Hansraj (Daman)(09825142600)

DELHI
DHS OfficeNodal Officer:Dr.R.P.Vashist

LAKSHADWEEP
Office of DHS,Tel:(04896)262316 [Office hours only]Nodal Officer:Dr.K P Hamza Koya (DHS)(09496429027,04896-262113),04896-262089,04896-262209(F)

PUDUCHERRY
Call Centre:(24X7) -Tel: (0413)1070Nodal Officer:Dr.G.S.Naidu (09443729783

SWINE FLU IN INDIA (WHO REPORT)

1. Activity: Updated information as of 09 August 2009:
Cumulative confirmed cases as of today: 864 cases
4 deaths
Age range of confirmed cases:
0-4 y.o. = 5%
5-14 y.o. = 33.97%
15-34 y.o. = 41.6%
35-59 y.o. = 18%
60+ y.o. = 1.5%
No Info age
Sex
Male: 49%
Female: 51%
2. Transmission: Local – localized clusters in household and schools reported in New Delhi and Pune.

3. Geographic Spread: Localized.

4. Trend: Slight increase in activity compared to last week

5. Intensity is Moderate

6. Impact : Low

DISTRIBUTION IN INDIA

Infection prevention and control in health care for confirmed or suspected cases

Background
On 11 June 2009, WHO raised its pandemic alert level from phase 5 to phase 6 and characterized the outbreak of pandemic (H1N1) 2009 as moderate. Since the first recorded cases in April 2009, the virus has spread rapidly across the globe resulting in sustained community transmission in numerous countries and at least two WHO regions.
Health-care facilities (HCF) face the challenge of providing care for patients infected with the pandemic (H1N1) 2009 virus. It is critical that health-care workers (HCW), patients, and visitors follow the appropriate infection control (IC) precautions in order to minimize the possibility of transmission associated with health care.
IC measures for pandemic (H1N1) 2009 should be in harmony with other IC measures and strategies in health care. It is particularly important to acknowledge and quickly identify other respiratory diseases that may require different IC measures (e.g. pulmonary tuberculosis) and that have the potential for being overlooked due to large numbers of patients with respiratory symptoms.
Human-to-human transmission of the pandemic (H1N1) 2009 virus appears to be primarily through droplets. Therefore, IC precautions for patients with suspected or confirmed pandemic (H1N1) 2009 virus infection, as well as those with influenza-like symptoms or illnesses, should ensure control of the spread of respiratory droplets. The document “Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care - WHO Interim Guidelines”1 provides detailed information on infection prevention and control precautions for influenza virus with sustained human-to-human transmission applicable for the current pandemic (H1N1) 2009. This guidance note summarizes and highlights the main issues contained in the aforementioned document.
This document has been developed to meet the urgent need for guidance and the recommendations are only valid until new guidance becomes available, at the latest until the end of 2009.

Fundamentals of infection prevention strategies
Administrative controls are key components in infection prevention strategies and include implementation and facilitation of IC precautions; patient triage for early detection, patient placement and reporting; organization of services; policies on rational use of available supplies; policies on patient procedures; and strengthening of IC infrastructure.
Environmental/engineering controls, such as basic HCF infrastructure,2 adequate environmental ventilation, proper patient placement and adequate environmental cleaning can help reduce the spread of some pathogens during health care.
Rational use of available personal protective equipment (PPE) and appropriate hand hygiene also help reduce spread of infection.
1 Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care WHO Interim Guidelines. WHO, 2007. Available at http://www.who.int/csr/resources/publications/WHO_CD_EPR_2007_6/en/index.html.
2 Essential environmental health standards in health care. WHO, 2008. Available at http://whqlibdoc.who.int/publications/2008/9789241547239_eng.pdf.

3 WHO Guidelines on Hand Hygiene in Health Care. WHO 2009. Available at http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf.
4 Standard Precautions: Basic precautions designed to minimize direct, unprotected exposure to potentially infected blood, body fluids or secretions applicable to all patients. Available at www.who.int/csr/resources/publications/standardprecautions/en/index.html.
5 PPE for Droplet Precautions: Health-care workers to wear medical mask if working within approximately 1 meter of the patient.
6 Groups at high risk: Infants and young children <5>65 years), nursing home residents, pregnant women, and patients with co-morbid conditions such as cardiovascular, respiratory or liver disease, diabetes, and those with immunosuppression related to malignancy, HIV infection or other diseases.
7 Details on the correct use of PPE are available at: http://www.who.int/csr/resources/publications/WHO_CD_EPR_2007_6/en/index.html
Critical infection control measures
Several measures are recommended in the context of pandemic (H1N1) 2009 and other epidemics. First, avoid crowding patients together (maintain a minimum distance of >1 metre between patients). Second, promote respiratory etiquette and hand hygiene by providing necessary supplies and training individuals in the proper use of medical masks and hand hygiene immediately after contact with respiratory secretions. Third, apply Standard4 and Droplet5 Precautions. Last, consider special arrangements for vulnerable groups at high risk6 for complications from pandemic (H1N1) 2009 viral infection.

Summary of infection control precautions in specific situations
1. Caring for patients with suspected or confirmed infection
For staff providing care for patients with suspected or confirmed pandemic (H1N1) 2009 infection and for patients with influenza-like symptoms, the following precautions should be taken.
1.1 When working in direct contact with patients, Standard and Droplet Precautions should always be applied.
As per Droplet Precautions:
• wear a medical mask, if working within or <>12 air changes per hour);
• avoid permitting unnecessary individuals into the room; and
• perform hand hygiene before and after patient contact, and after PPE removal.

8WHO Information for Laboratory Diagnosis of New Influenza A (H1N1)Virus in Humans. WHO, 2009. Available at http://www.who.int/csr/resources/publications/swineflu/diagnostic_recommendations/en/index.html.
Aspiration of the respiratory track may be associated with increased risk for disease transmission. Nasopharyngeal swabbing and the vigorous swabbing of tonsils for sample collection may trigger intense cough at very close distance to the person doing the procedure.
Clinical management of human infection with avian influenza A (H5N1) virus. WHO, 2007. Available at http://www.who.int/csr/disease/avian_influenza/guidelines/clinicalmanage07/en/index.html
PPE for Contact Precautions: Health-care workers should wear gowns and clean gloves when providing direct care.
IC recommendations for avian influenza in health-care facilities is available at: http://www.who.int/csr/disease/avian_influenza/guidelines/aidememoireinfcont/en/index.html .
2. Collection of laboratory specimens
Upper respiratory tract specimens are the most appropriate samples for laboratory testing of pandemic (H1N1) 2009 virus in humans. Samples should be taken from the deep nostrils (nasal swab), nasopharynx (nasopharyngeal swab), nasopharyngeal aspirate, and/or throat or bronchial aspirate. Blood samples may be used for serologic purposes (either during the acute or convalescent phases). In addition to Standard Precautions, specific IC precautions should be taken when collecting patient specimens as follows.
2.1 Nasal swab and nasal wash:
• use face protection (either a medical mask and eye-visor or goggles, or a face shield);
• wear a gown and clean gloves; and
• perform hand hygiene before and after patient contact, and immediately after removal of PPE.

2.2 Collection of nasopharyngeal aspirate, nasopharyngeal swab, throat swab or bronchial aspirate:
• follow the same precautions as for Aerosol generating procedures (above).

2.3 For the collection of blood:
• use a medical mask (if performed during the acute infectious phase);
• use clean gloves;
• perform hand hygiene before and after patient contact, and immediately after removal of PPE.

3. Infection control precautions for patient care in regions where both avian influenza A (H5N1) and pandemic (H1N1) 2009 have been reported Patients presenting with influenza-like illness (ILI) might be infected with different types of influenza virus (e.g. avian influenza A (H5N1) or pandemic (H1N1) 2009), as well as other respiratory pathogens. Epidemiological and clinical10 clues should be used in triage areas to identify and apply the appropriate infection prevention and control measures in accordance with the most likely diagnosis. Laboratory diagnosis should be pursued for etiological clarification. A laboratory confirmed diagnosis is not always available or might be delayed, but clinical clues and epidemiological link(s), such as contact with infected patients or animal exposures, can aid in the presumptive diagnosis of avian influenza A (H5N1) and pandemic (H1N1) 2009. For laboratory confirmed or suspect cases of avian influenza A (H5N1) infection, Standard plus Droplet plus ontact11 Precautions and eye protection should be applied when providing routine care.