Indian data on swine flu shamefully inadequate: Virologist

"Even though India has over 28,000 confirmed cases and 1,152 deaths - which would translate into manifold more - no epidemiological analysis of the Indian outbreak is found in the public domain," says Shahid Jameel of the International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi.

"We do not know the risk factors for the Indian population, the reasons for a mortality rate that is about three to four times the global average, or any epidemiological details of the terrifying spread in cities like Pune," Jameel wrote in the latest issue of the journal 'Current Science'.

There are also no genomic sequences from India uploaded in public databases, making it difficult to analyze the virus circulating in India, he said.

"Considering that  ICMR (Indian Council of Medical Research, New Delhi) has an entire national institute dedicated to disease epidemiology (National Institute of Epidemiology, Chennai), it is shameful that no epidemiological analysis of the outbreak is available," the scientist who heads the virology group in ICGEB noted with surprise.

He said it is imperative that such information be in the public domain for all stakeholders to analyse it and participate in the vaccination strategy.

Reacting to statements by ICMR and the health ministry that a vaccine against the H1N1 pandemic virus will soon undergo bridge trials in the country, Jameel wonders who will receive it.

"Have we identified the risk groups?", he asks pointing out that in the absence of any epidemiological analysis of the Indian outbreak it is difficult to select the recipients.

"Even in the presence of a public health preparedness plan, an early initiative to screen for the pandemic virus, and the government's generous spending on the testing initiatives, experts believe that a poor healthcare infrastructure has failed the country," Jameel said. "There is a clear need to strengthen that."

Jameel said the government's aggressive screening of passengers at ports of entry did help delay the spread of the virus in India by two to three weeks, but it eventually followed an expected pattern of spread - first in large urban centres followed by small towns. "We do not even know the situation in rural areas," Jameel said.

According to Jameel, daily updates being released by the health ministry since Aug 1, 2009, remains the only source of information on H1N1 spread in India. Based on the analysis of this limited data --  updated till Jan 20, 2010, - Jameel has concluded that H1N1 cases did increase in what appeared to be a second wave. "Since the 'mortality curve' runs almost parallel to the 'cases curve,'  and as the number of cases increase, we should be prepared for more deaths," he warns.

According to Jameel, an over-zealous media coupled with the government's perceived lack of transparency and an inherent mistrust of the government system created widespread panic and knee-jerk reactions. This is not good for dealing with any pandemic, he said.

Jameel predicted there will be more cases and   more deaths, but calm and sustained response (and not panic) is the only way to overcome it.

At the same time, he said, there is a need for more transparency from government institutions and the media should be considered partners in disseminating the message. "And the message is that this pandemic is serious but we have the tools to manage it."
Thankfully, the mortality is still low, said Jameel, the question remains if this virus will return in a more virulent form in the next wave.

"The 1918 pandemic started that summer as a mild disease, but in the next wave during winter, the virus came back in a highly virulent form, eventually infecting about a third of the world population and killing an estimated 40-50 million people."

According to the ICGEB scientist, "this history of pandemic flu is reason enough to exercise caution and limit virus transmission in the human population".