Statement by Shri Jagat Prakash Nadda, Union Minister of Health & Family Welfare- H1N1




Statement by Shri Jagat Prakash Nadda, Union Minister of Health & Family Welfare, in both the Houses of Parliament regarding Outbreak of H1N1 Seasonal Influenza and the steps taken by Government of India in this regard


1. I would like to inform the Hon’ble Members about the recent outbreak of Influenza A H1N1 in certain parts of the country. Even though the Influenza is of a seasonal nature with maximum impact during this time of the year, the morbidity and more important the mortality associated with the Influenza are matters of great concern for all of us.

2. Hon’ble Members may recall that India, as also other parts of the world, were affected by Influenza A H1N1 pandemic in year 2009 and 2010.The number of reported cases in 2009 were 27236 and in 2010 the cases were 20604. The number of deaths in 2009 were 981 and in 2010 the deaths increased to 1763. Influenza is caused by Virus of three types A, B and C. It is the type A virus which has caused major Pandemics and Epidemics across the globe. This is because Influenza A type of virus has the tendency to undergo mutation against which the affected population may not have sufficient immunity. The Subtypes of Influenza A virus include H1N1, H2N2 and H3N2. While declaring the pandemic to be over in August 2010, WHO had conveyed that the pandemic H1N1 virus would continue to circulate as a seasonal influenza virus for some years to come. In the current year, from January 1 till February 22, 2015 the number of cases reported by the States are 14673. The number of deaths for the same period are 841. For the information of the Hon’ble Members, year-wise figures of cases and deaths, from 2009 to 2015 reported for Influenza A H1N1 are being laid on the Table of the House (Annexure). Many of these deaths, however, may be due to already present co-morbidities in the patients.

3. The Union Health and Family Welfare Ministry has been very closely monitoring the Influenza A H1N1 situation. We are in regular contact with the Governments of the affected States. For containment of the impact of this seasonal influenza, States have been provided guidelines on screening, risk categorization of patients, clinical case management and ventilator management. The drug Oseltamivir is required for treating Influenza A H1N1. In addition, to prevent transmission of the disease to the healthcare workers who come in contact with patients, N-95 masks and Personal Protective Equipment are required. We are, on a regular basis, ascertaining from the State Governments regarding the stock position of the above items. Additional requirements, if any, required by the State Governments are being met by us. We have already supplied to the affected States 58,000 Capsules of Oseltamivir, 3000 N-95 masks and 9500 Personal Protective Equipment. We are also maintaining an emergency stock of Oseltamivir drug to meet any sudden requirement. In addition, we have in stock 10,000 N-95 masks and sufficient number of Personal Protective Equipment. To guide and assist the State Governments, teams from Union Health & Family Welfare Ministry have been sent to Telangana, Rajasthan, Gujarat, Maharashtra and Madhya Pradesh. For guidance on ICU & Ventilator management, a team of doctors was sent to Rajasthan on two occasions. Video conferences for review with the States are being held at the level of Secretary (Health & Family Welfare) and other Senior Officers. On 19th February, 2015, the Cabinet Secretary also held a Video conference with the Chief Secretaries of the affected States to ascertain the difficulties and assess the requirements, if any. Regular review is also taking place at my level. I can assure the Hon’ble Members that whatever help is required by the State Governments to deal with the Outbreak, is being provided by us.

4. Certain media reports have incorrectly stated about shortages of Oseltamivir, drug used for treating Influenza A H1N1. I would like to inform the Hon’ble Members that this drug, recommended by WHO, is manufactured in India. We have held meetings with the manufacturers on two occasions. These indigenous manufacturers have confirmed that they have sufficient capacity and stock of active pharmaceutical ingredients to meet requirements. In fact, one of the manufacturers is a Central Public Sector Undertaking. The drug Oseltamivir, however, cannot be sold over the counter. It is to be made available only against prescription by a qualified doctor and sold through a Chemist with license under Schedule X of the Drugs and Cosmetics Act. In addition, the drug is available through the public health system. We cannot afford a situation where due to irrational use of the drug, resistance is developed, rendering the drug incapable of fighting the virus. However, to ensure that general public requiring the drug does not face any inconvenience, we have advised the State Governments to review the locations of the Schedule X Pharmacies and issue fresh licenses for under-represented or not represented locations.

5. The laboratory network of Integrated Disease Surveillance Programme and Indian Council of Medical Research comprising 21 laboratories across different parts of India is providing free testing facilities for Influenza A H1N1. These laboratories have sufficient capacity and availability of diagnostic materials. The position is being constantly monitored. Orders have been placed already for procurement of additional quantity of reagents. The affected States have further supplemented these efforts by authorising private diagnostic laboratories for conducting tests. We were concerned about certain media reports informing that very high rates were being charged by certain private laboratories. The Director General of Health Services has advised the concerned State Government to ensure that the private laboratories do not charge high rates. Rather the rates should be fixed by the State Government.

6. It has been confirmed, both by National Institute of Virology (under ICMR) and National Centre for Diseases Control, (Delhi) that the cases of Influenza A currently being reported are of H1N1. In other words, it is the same virus of 2009 and there is no mutation in the virus. Consequently, the drug Oseltamivir used during the time of pandemic 2009-2010 remains effective for treatment now also. As already stated, we have the diagnostic capacity and we are equipped and capable of detecting this virus.

7. I would like to inform the Hon’ble Members that we have recommended vaccine only for the healthcare workers. Guidelines regarding the same have been sent to the State Governments. This decision has been taken after due consultations with experts. Vaccination of general public is not advocated as a public health strategy at this juncture. Hon’ble Members may also like to know that vaccination becomes effective after about three to four weeks of the injection and the immunity is only for about one year. Moreover, vaccination may not provide full protection against the virus. The healthcare workers are also advised to take proper precautions and use Personal Protective Equipment while examining and looking after Influenza A H1N1 patients. In addition, it is recommended for the healthcare workers to take prophylactic doses of Oseltamivir.

8. As per information gathered from the State Governments, it appears that many of the deaths may be attributed to the co-morbid conditions of the Influenza A H1N1 affected patients. Such persons are immuno-compromised and consequently more vulnerable. In this category are the patients with diseases such as cancer, diabetes, tuberculosis, other respiratory diseases etc. The States have also informed that in many cases, the affected persons sought medical intervention at a very late stage resulting in deteriorated health status of patients.

9. To increase awareness of the general public, the States have been undertaking massive Information -Education -Communication (IEC) campaign using different media. The campaign focus is on how to prevent the transmission of the disease as also on the action to be taken with the onset of symptoms such as cough, fever etc. The Central Government is also supplementing the IEC efforts of the States. Advertisements placed by us in print media were published on regular basis in more than 200 newspapers in January and February, 2015 all over the country. These also included advertisements in vernacular languages. Radio and Television are also being used for information dissemination. States have been advised already to scale up IEC activities.

10. I would like to assure the Hon’ble Members that the situation is being closely monitored by us and all necessary assistance is being provided to the State Governments. Adequate stocks of medicine, masks and PPE are available. I would further like to assure the Hon’ble Members that no efforts will be spared for effectively dealing with the situation.


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Promotion of Organ Donation

Since health is a state subject, the list of patients waiting for organs for organ transplantation is not maintained centrally.

Also, the primary responsibility to promote organ donation including cadaver donation is that of the state governments. The Government of India has, however, enacted the Transplantation of Human Organs Act, 1994 which has been further amended in 2011 to promote cadaver organ retrieval/donation and making organs available to the persons in need of suchorgans. Further, a National Organ Transplant Programme has also been approved to promote organ donation from deceased donors and a website www.notto.nic.in has been made operational to provide information related to organ donation and organ pledging. Awareness activities such as Organ Donation Runs and other activities are organized for dissemination of information to the public in general including in India International Trade Fair. These activities help in spreading the message regarding importance of and need for deceased organ donation. SMSs are also sent to NIC mail users.

The government is coordinating efforts with non-governmental organizations or associations working in the field of organ or tissue donation.

The Health Minister, Shri J P Nadda stated this in a written reply in the RajyaSabha here today.

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Preventing Wastage of Donated Eyes

The Government has taken note of the fact that thousands of donated eyes are left unused/wasted in government eye banks across the country.

The number of eye donations which have taken place in the country in the last three years (2011-12, 2012-13 and 2013-14) and number of these donated eyes which could actually be used for keratoplasty, as reported by States/UTs,  is as under:

Year
No. of donated eyes collected
No. of donated eyes used for keratoplasty
2011-12
49,412
21,045
2012-13
53,542
21,197
2013-14
51,354
22,384

All eyes once collected from the donors are preserved in an appropriate medium for prospective use viz. full thickness keratoplasty, partial thickness keratoplasty. Collection of eyes beyond 6 (six) hours of death results in degraded cornea. Tropical climate and high temperature results in poor quality of corneas.

Before, transplantation, the collected corneas are assessed by specialists by using specular microscope for quality and suitability for optical keratoplasty. However, corneas not suitable or fit for optical keratoplasty are utilized either for therapeutic keratoplasty or for training and research purposes.

The following steps have taken under NPCB to promote eye donation in India:

i)                    Strengthening of Eye Banks and Eye Donation Centers in the country by providing required ophthalmic equipments  and manpower;
ii)                  Collection of eyes by Eye Banks from willing donors after their death and also from those patients who die in hospitals through “Hospital Corneal Retrieval Programme” for timely transplantation of cornea;
iii)                Appointment of Eye Donation Counselors in the identified Eye Banks to promote eye donation and timely collection of donated eyes;
iv)                Information Education Communication (IEC) is an on-going activity under NPCB to promote eye banking and eye donation.  The following events/activities are undertaken to promote awareness about eye donation under the programme:
·            Radio programme – Ankhein Hain Anmol
·            Television Programmes –  Swasth Bharat
·            Eye Donation Fortnight from 25th August to 8th September
·            World Sight Day on 2nd  Thursday of October
·            Continuation of dedicated phone line 1919 automatically linked with the area Eye Banks in metro cities
·            Printing and distribution of NPCB newsletter to all eye surgeons in the country
·            Promotion through print and electronic media
·            Organizing rallies in public places
·            Poster competitions amongst school children
·            Honouring donor families in the annual functions organized by major eye banks during Eye Donation Fortnight.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.


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Measures to Control Dengue


The Government of India developed a Long Term Action Plan and advised the States for implementation in January, 2007. Subsequently, a Mid Term Plan for prevention and control of Dengue duly approved by the Committee of Secretaries on 26.5.2011 was sent to the States for implementation. National guidelines for clinical management of dengue have been revised in December, 2014 and shared with states. Periodic reviews with the States are carried out and Advisories are also issued from time to time. Field visits are carried out to assess the preparedness of the States and to provide technical guidance.Focused IEC/BCC activities are carried out for awareness generation of the community at national and State level. ASHAs are also involved in source reduction activities for dengue prevention and control. For augmenting diagnostic facilities, the number of Sentinel Surveillance Hospitals (SSHs) with laboratory support has been increased from 110 to 439 across the country and linked with 15 Apex Referral Laboratories with advanced diagnostic facilities for back up support for Dengue and Chikungunya. Test kits are provided to these institutes free of cost through National Institute of Virology, Pune. ELISA based NS1 test for early detection of cases from 1st day of disease is being used. This is in addition to IgM test which can detect the Dengue cases after five days of disease.

The number of deaths reported due to Dengue in the country during the last three years is as under:

Year
Deaths
2012
242
2013
193
2014
131

State-wise details are given below:-

State-Wise Dengue Deaths in the Country during 2012 to 2014

Sl. No.
State
2012
2013
2014
1
Andhra Pradesh
2
1
5
2
Arunachal Pradesh
0
0
0
3
Assam
5
2
0
4
Bihar
3
5
0
5
Chhattisgarh
0
2
9
6
Goa
0
2
1
7
Gujarat
6
15
3
8
Haryana
2
5
2
9
Himachal Pradesh
0
2
0
10
 Jammu & Kashmir
1
3
0
11
Jharkhand
0
0
0
12
Karnataka
21
12
2
13
Kerala
15
29
11
14
Madhya Pradesh
6
9
13
15
Meghalaya
2
0
0
16
Maharashtra
59
48
54
17
Manipur
0
0
0
18
Mizoram
0
0
0
19
Nagaland
0
0
0
20
Odisha
6
6
9
21
Punjab
9
25
2
22
Rajasthan 
10
10
7
23
Sikkim
0
0
0
24
Tamil Nadu
66
0
3
25
Tripura
0
0
0
26
Telangana
0
0
1
27
Uttar Pradesh
4
5
0
28
Uttrakhand
2
0
0
29
West Bengal
11
6
4
30
A&N Island
0
0
0
31
Chandigarh
2
0
0
32
Delhi
4
6
3
33
D&N Haveli
1
0
1
34
Daman & Diu
0
0
0
35
Puducherry
5
0
1
36
Lakshadweep
Not reporting
TOTAL
242
193
131

The Health Minister, Shri J P Nadda stated this in a written reply in the RajyaSabha here today.


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Preventive Measures for Swine Flu

The number of cases and deaths reported for Influenza A H1N1, year-wise and State/UT wise from 2009 to 2015 is given below:-

Influenza A H1N1 (Swine Flu) – State/UT- wise, Year- wise for

                                 2009, 2010, 2011, 2012, 2013 2014 and 2015


S. No.
  State
May,2009 -Dec,2009
Jan,2010 -Dec,2010
C
D
C
D
1.
Andaman & Nicobar
25
0
2
0
2.
Andhra Pradesh
777
52
733
49
3.
Arunanchal Pradesh
0
0
0
0
4.
Assam
47
1
5
1
5.
Bihar
7
0
0
0
6.
Chandigarh(UT)
257
8
75
0
7.
Chhattisgarh
46
2
50
12
8.
Dadra & Nagar Haveli
1
1
2
0
9.
Daman & Diu
1
0
0
0
10.
Delhi
8439
72
2725
77
11.
Goa
63
5
68
1
12.
Gujarat
697
125
1682
363
13.
Haryana
1888
34
216
16
14.
Himachal Pradesh
14
7
10
3
15.
Jammu & Kashmir
93
2
20
2
16.
Jharkhand
1
0
1
0
17.
Karnataka
1872
138
2575
116
18.
Kerala
1579
32
1533
89
19.
Lakshadweep
0
0
0
0
20.
Madhya Pradesh
20
8
395
110
21.
Maharashtra
4594
270
6814
669
22.
Manipur
1
0
1
0
23.
Meghalaya
8
0
0
0
24.
Mizoram
4
1
0
0
25.
Nagaland
2
0
0
0
26.
Orissa
26
3
92
29
27.
Pondicherry
87
6
50
6
28.
Punjab
114
33
139
14
29.
Rajasthan
3032
150
1710
153
30.
Sikkim
0
0
0
0
31.
Tamil Nadu
2062
7
1184
13
32
Telangana
-
-
-
-
33.
Tripura
0
0
0
0
34.
Uttarakhand
129
10
25
7
35.
Uttar Pradesh
1215
14
376
29
36.
West Bengal
135
0
121
4
Cumulative Total
27236
981
20604
1763

S. No.
  State
Jan,2011-Dec,2011
Jan,2012-Dec,2012
C
D
C
D
1.
Andaman & Nicobar
0
0
0
0
2.
Andhra Pradesh
11
1
326
34
3.
Arunanchal Pradesh
0
0
0
0
4.
Assam
0
0
0
0
5.
Bihar
1
0
0
0
6.
Chandigarh(UT)
0
0
1
0
7.
Chhattisgarh
0
0
10
3
8.
Dadra & Nagar Haveli
0
0
0
0
9.
Daman & Diu
0
0
0
0
10.
Delhi
25
2
78
1
11.
Goa
7
0
9
0
12.
Gujarat
7
4
101
30
13.
Haryana
6
4
18
5
14.
Himachal Pradesh
14
3
2
2
15.
Jammu & Kashmir
13
1
0
0
16.
Jharkhand
0
0
0
0
17.
Karnataka
100
12
878
48
18.
Kerala
210
10
623
14
19.
Lakshadweep
0
0
0
0
20.
Madhya Pradesh
9
4
151
26
21.
Maharashtra
26
5
1551
135
22.
Manipur
0
0
0
0
23.
Meghalaya
0
0
0
0
24.
Mizoram
0
0
0
0
25.
Nagaland
0
0
0
0
26.
Orissa
0
0
2
0
27.
Pondicherry
1
0
63
2
28.
Punjab
46
14
13
4
29.
Rajasthan
36
11
343
60
30.
Sikkim
0
0
0
0
31.
Tamil Nadu
34
4
750
40
32
Telangana
-
-
-
-
33.
Tripura
0
0
0
0
34.
Uttarakhand
0
0
1
1
35.
Uttar Pradesh
57
0
124
0
36.
West Bengal
0
0
0
0
Cumulative Total
603
75
5044
405


S. No.
  State
Jan, 2013-       Dec, 2013
Jan, 2014-       Dec, 2014
Jan, 2015- 22.02.2015
C
D
C
D
C
D
1.
Andaman & Nicobar
0
0
0
0
0
0
2.
Andhra Pradesh
71
8
10
5
82
12
3.
Arunanchal Pradesh
0
0
0
0
0
0
4.
Assam
0
0
0
0
0
0
5.
Bihar
0
0
0
0
0
0
6.
Chandigarh(UT)
37
5
0
0
13
3
7.
Chhattisgarh
1
1
0
0
4
0
8.
Dadra & Nagar Haveli
0
0
0
0
0
0
9.
Daman & Diu
0
0
0
0
1
0
10.
Delhi
1511
16
38
1
2241
8
11.
Goa
0
0
1
1
7
1
12.
Gujarat
989
196
157
55
3107
207
13.
Haryana
450
41
5
0
137
20
14.
Himachal Pradesh
0
0
0
0
21
4
15.
Jammu & Kashmir
76
2
0
0
56
6
16.
Jharkhand
0
0
0
0
0
0
17.
Karnataka
122
19
303
33
699
36
18.
Kerala
10
1
62
15
36
6
19.
Lakshadweep
0
0
0
0
0
0
20.
Madhya Pradesh
113
32
17
9
630
112*
21.
Maharashtra
643
149
115
43
 1013
99
22.
Manipur
0
0
0
0
0
0
23.
Meghalaya
0
0
0
0
0
0
24.
Mizoram
20
1
0
0
1
0
25.
Nagaland
0
0
0
0
3
0
26.
Orissa
0
0
0
0
11
3
27.
Pondicherry
0
0
0
0
12
1
28.
Punjab
183
42
27
6
150
35
29.
Rajasthan
865
165
64
34
4549
214
30.
Sikkim
0
0
0
0
0
0
31.
Tamil Nadu
37
6
58
8
251
9
32
Telangana
-
-
78
8
1316
51
33.
Tripura
0
0
0
0
0
0
34.
Uttarakhand
24
7
0
0
14
3
35.
Uttar Pradesh
98
8
2
0
250
6
36.
West Bengal
3
0
0
0
69
5
Cumulative Total
5253
699
937
218
14673
841





Abbreviations:  C-Cases, D- Deaths


All the deaths may not have occurred only due to Influenza A H1N1 infection but may also be due to co-morbid conditions (Lung disease, liver disease, kidney disease, blood disorders, Diabetes etc.) and due to patients being Immuno-compromised. The first information of Influenza A H1N1 case was in May, 2009 in Hyderabad.


Health is a state subject.  However, the Central Government monitors the Influenza A H1N1 situation and remains in regular touch with the affected State Governments.  While declaring the Influenza A H1N1 Pandemic to be over in August, 2010, WHO had conveyed that the Pandemic virus would continue to circulate as seasonal influenza virus for some years to come. For combating outbreak of Influenza A H1N1, the States have been provided guidelines on screening, risk categorization of patients, clinical case management and ventilator management.  To guide and assist the State Governments, teams from Union Health and Family Welfare Ministry are sent as per need.  The Central Government also assists the State Governments by providing logistic support for drug, masks and Personal Protective Equipments.

The Integrated Disease Surveillance Programme regularly collects data on outbreaks of communicable diseases including Influenza A H1N1 from different parts of the country.  This data is monitored and analyzed to facilitate quick response to contain outbreaks.  In addition to the guidelines for combating Influenza A H1N1 already provided to the State Governments, the Central Government has also established a network of laboratories equipped to test the virus.  Emergency stock of Oseltamivir drug, N-95 masks and Personal Protective Equipment is also being maintained. A Committee under the Director General of Health Services regularly monitors the situation.  There is no delay in taking steps to contain and respond to outbreak.

The Health Minister, Shri J P Nadda stated this in a written reply in the Rajya Sabha here today.



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Statement by Shri Jagat Prakash Nadda, Union Minister of Health & Family Welfare- H1N1 Statement by Shri Jagat Prakash Nadda, Union Minister of Health & Family Welfare- H1N1 Reviewed by Ajit Kumar on 10:56 PM Rating: 5

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