The unabated rise in the number of swine flu cases, involving chiefly people who have returned to India after picking up the infection abroad, points to laxity in screening incoming passengers at the country’s international airports. This should be a cause of concern, and something that the government needs to address without delay. The World Health Organisation (WHO) has already declared the H1N1 influenza as a pandemic, with the highest (Phase-6) level of risk in terms of its potential for spreading across the globe. Already about 75 countries have been affected by this disease, though the highest number of H1N1-positive cases as well as deaths due to it, totalling over 140, have been reported from just six countries in South, Central and North America — Mexico (where the infection originated), the US, Canada, Chile, the Dominican Republic and Costa Rica.
What is being done in India is to selectively screen people coming in from the key affected countries, but this is not enough. All travellers coming from abroad need to be monitored. Fortunately, so far, the international airports have been the only entry points and humans the only carriers of this infection. That makes it relatively easy to check its entry (unlike in the case of bird flu, where the infection carrier birds could get in from any point and intermingle with local birds to pass on the virus). But any lapses in checking for swine flu virus at the entry points can prove far more perilous than was the case with bird flu, as means like culling of birds and prohibition of their restocking for containing the pathogens at the foci of infection is ruled out.
In its current form, the H1N1 virus is said to be quite mild, and the least deadly of all the strains that have caused previous major influenza pandemics — Asiatic flu (1889-90, 1 million deaths) Spanish flu (1918-20, over 40 million deaths), Asian flu (1957-58, 1.5 million deaths) and Hong Kong flu (1968-69, 1 million deaths). But that does not rule out its transformation into a more virulent version. Though WHO has found no role played by animals in the epidemiology or spread of this disease, the H1N1 strain is believed to be a result of the combination and subsequent re-assortment of the swine flu, bird flu and human flu viruses.
Since the bird flu virus H5N1 is still active in India (the latest incidence was reported less than a month ago in the Uttar Dinajpur area of West Bengal), the chances of this virus inter-acting with the bird flu and various local strains of human influenza to assume an entirely new and unpredictable avatar cannot be ruled out. What is worse, though the post-outbreak management of the H1N1 virus may not be a difficult task, especially if the disease remains as curable as it is today, the prevention of its human-to-human spread is far from easy as the role of vaccines is unclear.
Several global pharmaceutical firms have already made investments in developing H1N1-specific vaccines, but even they are unsure of what the demand for this will be. Many public health experts disfavour mass scale vaccination against such maladies as it tends to make the virus develop immunity against the available vaccines and drugs, and perhaps to mutate into new forms. Thus, the only course available for India to remain unscathed from this scourge is to ensure strict monitoring of international travellers at all entry points.
