Maharashtra: H1N1 stings 41-60 age group with 201 fatalities

MUMBAI: Nearly two out of three H1N1 influenza virus victims this year from the state were perfectly healthy with no history of any underlying chronic disease. A departure from previous years, where a majority of deaths and complications were seen in ailing and elderly people with compromised immune systems, the worrying trend of the healthy falling prey has experts scurrying for answers.
While H1N1, often known as swine flu, does claim lives of some healthy people every year, that percentage is much less compared to those suffering from diabetes, hypertension, hypothyroidism, among other common conditions. This year, this high-risk group accounted for only 39% (146) of 376 deaths as opposed to 230 deaths in people with no disease history. Among comorbid conditions, people with diabetes and hypertension were most susceptible as 109 of 146 had either of the conditions or both. Nine had hypothyroidism, while a handful was co-infected with dengue, HIV, tuberculosis and hepatitis.
The rising instances of H1N1 influenza virus victims with no history of any chronic disease is a new headache for health officials. "It's a matter of concern and we are trying to understand why it has happened," said Dr Pradeep Awate, Maharashtra's epidemiologist, suggesting that it was a rare trend.
"We have also looked into whether the virus has undergone any change, but experts at the National Institute of Virology in Pune have noticed nothing unusual so far," he said, adding that discussions are revolving around the body's immune response.

Infectious disease expert Dr Om Srivastava concurred that some of the answers perhaps lie there. He explained that when a virus attacks an individual, there are two-three explanations why one might succumb rapidly.
"First and most talked about is the cytokine storm, which refers to a state where the body's own immune response to the attack is overwhelming so much so that it can damage organs, particularly the lungs and kidneys, and even lead to death," he said. He added that in several deaths as well as cases this season, the involvement of kidney was little more than usual.
Besides cytokine storm, Dr Srivastava said that co-infection with another pathogen could complicate matters even for healthy individuals. "Combined with that if there is a delay in seeking care, it could deal a serious blow," he said. A delay in seeking care and receiving the right antiviral was also found to be responsible for several complications and deaths this season.
An age-wise analysis of the deaths showed that maximum casualties (201) were between 41-60 years. "Even in the past we have seen deaths in this group, which is working and therefore mobile," said Dr Awate. Next was the age bracket of 26 to 40 that witnessed 84 deaths. Unlike the west where the majority of deaths are seen in the 60-plus bracket, here around 16% deaths were in senior citizens.
Did vaccination play a role in protecting the elderly or not doing the same for healthy individuals who most likely were not vaccinated. Numbers suggest a little over 1.28lakh people were vaccinated against H1N1. "At any given point only around 10% of our population is immunized, including pregnant women. We are anyway not covering the entire risk population, so lack of vaccination seems to be an unlikely cause," he added. Among the deceased were also 13 pregnant women, the state data showed.
Gender didn't seem to be a factor in the influenza activity as the ratio of male-female casualties were almost the same. However, intriguingly, 81% of the deaths were seen in private hospitals, raising questions about timely detection and treatment.