The worldwide pandemic- Influenza A (H1N1): Is Nepal Prepared?

The government of Nepal must ensure that no stone is left unturned, and it must not hesitate to work with Private and Public institutions to achieve this.

By Sameer M Dixit

The World Health Organization (WHO) recently announced that H1N1 (Swine influenza) is now a pandemic ( 11 th June 2009). Swine Influenza virus strains fall under the subtypes of the influenza A virus known as H1N1, H1N2, H3N1, H3N2, and H2N3 as well as the Influenza C virus. The current outbreak of the so called “swine flu” has been found to be caused by a new strain of Influenza A virus subtype H1N1. Now correctly classified under H1N1, this virus was first detected in humans in Mexico during March/April of 2009, although H1N1 transmission between pigs has been diagnosed as early as 1930. Since its first detection, there are now almost 30,000 confirmed cases have been reported in 74 countries (June 11 data, WHO). The US, Mexico, Australia and Canada are the most affected countries and amazingly except for Australia, those are North American countries. The US alone has more than 13,000 people infected while Australia harbours almost 1400 infections. These figures clearly show that in less than 3 months, this infection has spread rapidly from southern-northern hemisphere to southern- southern hemisphere.

Seasonal influenza, that sweeps the globe at regular intervals, is an acute viral infection caused by an influenza virus. To date, three types of the seasonal virus have been typed-A, B and C. Influenza A and B are known to occur more frequently than C. Among many subtypes of influenza A viruses, currently influenza A(H1N1) and A(H3N2) subtypes are circulating among humans. Vaccines being developed against influenza target only influenza A and B viruses as compared to C virus due to its low incidence in the human population. Influenza A is a single stranded RNA virus with eight different segments. When two viruses co-infect the same cell, new viruses can be produced that contain segments from both parental strains. Thus the possibility of strain variations within a given subtype of Influenza virus is very high. This adds to the difficulty is developing a vaccine against the virus.

Preparedness in Nepal:

If official governmental results are to be taken into account, there has been no case of H1N1 outbreak, to date. This may indeed be good news, considering Nepal is a tourist country with a large inflow of passengers via air and road every month. Our closes neighbours India (14 cases) and China (200) as well as some of our other target tourist countries- Japan (551), Germany (122), Korea (58), Israel (73) have recorded cases of H1N1 in the last three months. An amazing finding is that besides India, none of the SAARC member countries have reported a single case of H1N1 outbreak to date. Can this be attributed to high immunological resistance of us South Asians to H1N1 or is it simply due to lack of accurate diagnostic facilities setup in these countries? At least in Nepal, it is a clear fact that accurate testing facilities do not exist at the governmental level for the detection of H1N1 here.

The polymerase chain reaction (PCR) test used for detecting this and other similar viruses go through three stages- first check whether it really is the flu virus, and then the two tests that confirm the H and N type. Samples are sent overseas to confirm the identity of the virus in question. There is only one privately owned facility in Nepal, Intrepid Nepal that is capable of carrying out confirmatory tests for H1N1 as well as a number of influenza strains including Avian Influenza. However it appears that government apathy towards private institution is preventing accurate and timely detection of dangerous virus's right here in Nepal.

How scared should we be of H1N1:

Going back to the statistics, it is clear that almost 30,000 individuals have fallen ill due to H1N1 infection worldwide. In the same time period, there have been 153 confirmed H1N1-related deaths worldwide. In simple calculation, that is 0.527 percent of the infected population. A look at the mortality rate due to H5N1 (Avian Influenza) infection shows a completely different picture: over the last six years, there have been a total of 433 cases of infection reported to WHO, out of which 262 were fatal (60.5%). Lastly, there are 3 to 5 million cases of seasonal flu related viral infection worldwide with 250,000 to 500,000 deaths annually (10%).

The numbers above tell us the reason why Influenza A (H1N1) infection is a cause for alarm- that there is a high incidence of this infection in a very short time. Even Avian Influenza with its high mortality rate doesn’t infect as many humans this fast. However, in terms of mortality, H1N1 has the lowest mortality rate, even lower than the seasonal flu. WHO has already stated that most affected individuals will show signs of normal flu and recover from it in a similar fashion. And, as is the case with seasonal flu, the elderly and the very young are most vulnerable to infection. Probably the reason to be worried about H1N1 is that it’s a mutation of the seasonal flu virus Influenza A, which can mix and match its virulence genes H and N. If two strains of H1N1 were to come together into a human being, this could give rise to a third type of strain, of a totally new type. In terms of virulence (or ability to cause serious damage to the body), this could be stronger or weaker. For example a combination between H1N1 and H5N1 (Avian influenza) is scientifically possible.

It is time that Nepal gears up for the worldwide epidemic. We cannot continue to take the threat of H1N1 lightly. While this virus may not be as lethal as the Avian Influenza or normal influenza virus, there are always chances that it may mutate to be one. The sooner we set up our diagnostic facilities for accurate detection and monitoring of the virus in the population, the safer we shall feel. The government of Nepal must ensure that no stone is left unturned, and it must not hesitate to work with Private and Public institutions to achieve this.

(Sameer M Dixit, PhD, is Country Director, Center for Molecular Dynamics Nepal and can be reached at s.dixit@cmdn.org)

(Editor’s Note: Nepalis, wherever they live, as well as friends of Nepal around the globe are requested to contribute their views/opinions/recollections etc. on issues concerning present day Nepal to the Guest Column of Nepalnews. Length of the article should not be more than 1,000 words and may be edited for the purpose of clarity and space. Relevant photos as well as photo of the author may also be sent along with the article. Please send your write-ups to editors@mos.com.np)

Have your say ! (Registration required)