Seasonal flu far more common than coronavirus, but its vaccine is not popular in India

While vaccine for coronavirus will take another year to be developed, India needs to do more to prevent seasonal flu that kills despite having a vaccine, say health experts.

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New Delhi: With coronavirus spreading across the world, drugmakers are racing to develop a vaccine for it. But the far more common and recurrent H1N1 seasonal flu, which is serious too and is even preventable by a vaccine, does not get “enough thought”, experts believe.

India has reported 43 cases of coronavirus until Monday, with patients testing positive for COVID-19 in different parts of the country.

The Union Ministry of Health Affairs has advised against mass gatherings until the spread of the disease is contained. Face masks and hand sanitisers are flying off the shelves, and doctors across the country have reported patients in their outpatient departments fearing they have the coronavirus.

While the vaccine for COVID-19 will take another year to be developed, medical experts told ThePrint that India needs to do more to prevent seasonal flu that kills people despite having a vaccine.

“Symptoms like fever, dry cough, tiredness are similar for both coronavirus and influenza,” said Dr Atul Gogia, internal medicine and infectious disease specialist at Sir Ganga Ram Hospital in New Delhi.

The only way to distinguish the cause of the infection is through a laboratory test of throat swab.

“Testing is not recommended for all patients because most cases are mild,” said Dr Karan Madan, pulmonologist, All India Institute of Medical Sciences, Delhi. For mild cases, symptomatic treatment of taking plenty of fluids and Paracetamol is enough.

The same precautions of regular hand-wash, covering mouth and nose while coughing and sneezing, avoiding close contact with sick people and not touching the face and nose, help prevent influenza too.

Seasonal flu can lead to severe illness and even death

While most cases of seasonal flu or influenza are mild, which get better without medical treatment, influenza can also lead to severe illness and even death.

“We do not give influenza enough thought but half a million people die of it across the planet. It is not a figure to be scoffed at,” Dr Om Srivastava, infectious disease specialist at Mumbai’s Jaslok Hospital, tells ThePrint.

While 3.4 per cent of reported COVID-19 cases have died globally, seasonal flu generally kills far fewer than 1 per cent of those infected, Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), said on 3 March.

According to the WHO, there have been three to five million cases of severe illness due to influenza, and about 290,000 to 650,000 respiratory deaths.

Out of the four kinds of influenza viruses, H1N1 influenza A subtype is known to cause severe illness. “Seventy per cent of the deaths due to H1N1 are due to respiratory failure and the rest are due to organ failure,” said Dr Srivastava.

Since the 2009 H1N1 pandemic, India has seen a steady number of H1N1 cases in both winter and post monsoon season.

According to the National Centre for Disease Control, there were 28,798 H1N1 cases and 1,218 deaths in 2019 — meaning a death rate of 4.2 per cent.

Till February 2020, the number of H1N1 cases was 1,132 with 18 reported deaths.

Delhi has seen the highest number of 226 cases this year, including six Supreme Court judges who tested for H1N1.

While most patients would recover from H1N1, those with comorbid conditions like diseases of lung, heart, liver, kidney, blood disorders and diabetes have higher death rate.

Influenza vaccine not popular in India

Despite being recommended by doctors, influenza vaccine is not popular in India.

While the vaccine needs to be taken every year, it may not protect against all strains of the disease, though reduces the severity.

The WHO recommends vaccination for pregnant women, children below the age of five, those above the age of 60, those with chronic conditions and healthcare workers.

While India does not have a national seasonal flu vaccination policy, the National Centre for Disease Control recommends it for healthcare workers, pregnant women, children from six months to eight years and those with suppressed immunity.

Quadrivalent vaccine providing protection against two strains of influenza A and influenza B is recommended in India.

“Since vaccines cannot be given when a patient is unwell, when we ask them to come back in ten days, they rarely do,” said Gogia from Sir Ganga Ram Hospital. Most patients are reluctant because they don’t think it is needed and because of their bias against vaccination.

The cost of the quadrivalent vaccine is Rs 1,200-2,000, and many think it is not necessary. However, compared to even a day’s hospitalisation, the cost is miniscule, said Gogia.

Most patients are keen to take the vaccine when there is already an outbreak of H1N1, which is often too late as it takes about two-three weeks for immunity to develop. Most doctors recommend taking the flu vaccine in the beginning of the winter season to give protection during the season.

A healthy person may get the flu and get better but in the elderly or those with weak immunity, the same influenza may lead to pneumonia or respiratory failure etc, which makes the vaccine crucial, said Dr Rajani Bhat, pulmonologist.

“For patients who cannot be given the vaccines, like those who are allergic or when vaccines are less effective in patients of organ transplants, we recommend their family members to take it so that the patients are not exposed,” she said.