India reports 64th death

The anxiety about H1N1 is palpable in the urban center of Bangalore…and seemingly on no ones radar screen in the more rural areas of Kerala.  Yesterday India reported its 64th from H1N1.  To have some perspective I was data mining the Web yesterday to learn about the annual Indian seasonal flu experience – turns out India does not keep statistics on the number of cases or deaths for seasonal flu. There are no details on the number of flu infections and mortality available for India at all.  The government has reported they will begin surveillance this year.

A Pretty Typical Indian Traffic Scene
A Pretty Typical Indian Traffic Scene

Now to keep all of this in perspective, consider this…300 Indians die daily from auto accidents.  WHO conducted a survey in 178 countries, which account for 98 per cent of world’s population. The survey is based on data collection for 2006; it began in March 2008 and was completed in September, with further validation. India leads with 1,05,000 traffic deaths in a year, compared with over 96,000 in China. Also, in India an estimated two million people have disabilities resulting from a road traffic crash.  In the same time period the US reported 42,642 deaths.

And yet no one is jumping up and down about 300 deaths a day on the roads – that is acceptable risk.  But those 64 deaths from H1N1…

Eurosurveillance – Well Worth Checking Out

Eurosurveillance is a free electronic publication from the European Centers for Disease Control (ECDC).  It has excellent well-documented publication with a global perspective.  If you do work or your company does work abroad, add this to your bookmarks.

Epidemiology Of Fatal Cases Associated With Pandemic H1n1 Influenza

This article published August 20, 2009 in Eurosurveillance has no new information per se but it is a thoughtful discussion of the findings and a good review of fatal cases of H1N1 as of July 16 2009.

Deaths Associated With H1N1 Worldwide As Of July 16, 2009
Deaths Associated with H1N1 Worldwide as of July 16, 2009

The pandemic, however, is far from over, and deaths will unfortunately continue to occur. As in previous pandemics, available data show that age groups are not equally affected.

  • Compared to younger age groups, the elderly seem to be protected from infection to some extent, perhaps due to previous exposure to strains akin to influenza H1N1virus.
  • When infection does occur, however, the percentage of deaths in elderly cases seems to be higher than in others.
  • Initial estimates available from Mexico for the period until 16 July 2009 showed that the risk of death in aged cases (over 50 years) was higher (6% deaths among cases) than in children (0-1% deaths among cases aged 0-19 years) and young adults (2-4% deaths among cases aged 20-49 years).
Underlying Conditions Associated With Flu Deaths 2009
Underlying Conditions Associated with Flu Deaths 2009

There was documented underlying disease in at least 49% of documented fatal cases worldwide to date.

  • Diseases most frequently associated with death were the same as those identified for death from seasonal influenza.
  • Nevertheless, two risk factors are noticeable: pregnancy and obesity.

Pregnancy is a well-documented risk factor for severe infection and death in seasonal influenza and in previous pandemics. The role of obesity, however, remains to be further analysed in order to ascertain whether the risk is linked with complications of obesity during intensive care or with a severe course of disease due to diabetes frequently associated with obesity, or whether obesity plays a specific role in the pathogenesis of severe influenza H1N1infection, for example by interfering with the host’s immune responses, as has been shown in rodents.