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A Study of Outbreak of Swine Flu (H1N1) in North - West Zone of Rajasthan (Current Status - 2015).

BACKROUND
The outbreak of H1N1 virus had previously reported in India during 2009 ﬂu pandemic. In 2015, the outbreak became widespread throughout India. The states of Gujarat and Rajasthan are severely elected. We studied an outbreak of H1N1 Virus in north-west zone of Rajasthan 2015.


OBJECTIVE
To demonstrate the current epidemiological scenario of swine flu (H1N1) in north-west zone of Rajasthan with different demographic factors.


METHODS
We screened total 6390 patients. Out of them 1405 samples of suspected cases collected from different parts of north-west Rajasthan and analyzed by RT-PCR at Sardar Patel Medical College, Bikaner.


RESULTS
A total of 1405 samples examined during three and half months period, out of which 181 cases found positive for H1N1. Out of them 85 (46.97%) males and 96 (53.03%) females (M:F=1:1.13). Most patients (116) were in age group 21-50 years which was 64.09% of total positive cases (Mean age=37.09 ± 16.07years). The mean time of onset of symptoms to hospitalization was 5.12 ± 3.38 days. Only 11.05% patients presented within 48 hours whereas 64.09% presented between 3-5 days of onset of symptoms. 109 (60.22%) patients were from rural areas, whereas 72 (39.77%) belonged to urban areas. Total 13 (7.18%) deaths occurred among positive cases. 69.23% deaths were recorded in the age group of 25 to 50 years. The mean age of death being 44.69 years. Females had significant higher mortality (9 females out of 13 deaths). 76.92% died within 3 days of hospitalization, despite of starting Oseltamivir in a dose of 150 mg/bd on the day of admission. 84.61% of the patients who died had one or more risk factors. Bilateral pneumonia was observed in all the 13 patients and MODS in 2 patients.


CONCLUSIONS
With the above observation of swine flu trend it is likely that incidence is more in young to middle age group, majority of them having no risk factors, should form the target of future studies. However fatality is highest in patients with co-morbid condition or predisposing risk factors need to vaccinate this group should form a basis on which future directions and interventions have to be built up to reduce the morbidity and mortality. Females have slightly increased susceptibility for infection M:F=1:1.13). but mortality is much higher in this sex group. More patients belong to rural areas reflecting the need of creating public awareness especially in rural areas at primary health centre level and where illiteracy is common and crowded urban areas to present early at screening centres, so future outbreak can be prevent. The in-hospital mortality of 7.18% despite of starting Oseltamivir has raised concern about identifying the so called "Rapid Progressors" [76.92% died within 3 days of hospitalization]. Despite of all mortality is less in north-west zone as compared to rest of Rajasthan.