India has officially reported two H3N2 influenza-related deaths, with the first case from Karnataka. The other death has been reported from Haryana.
According to the Commissioner of Health and Family Welfare Department of Karnataka, D Randeep, the deceased has been identified as 87-year-old Hire Gowda from Hassan. It is to be noted that he had several pre-existing comorbid conditions — hypertension, asthma, and acute kidney injury.
Speaking to South First, Randeep said, “There is no need to panic. This death seems to be on account of the age of the person and comorbidity status. Patient had comorbidities and he was admitted with symptoms of influenza on 24 February. He died on 1 March and his samples came back with a confirmation of H3N2 influenza on 6 March.”
The Union Health Ministry, on Friday, 10 March, said that it is keeping a close watch on the situation and cases are expected to decline from month-end.
Latest data on influenza
According to the latest data available on IDSP-IHIP (Integrated Disease Surveillance Programme — Integrated Health Information Platform), a total of 3,038 laboratory-confirmed cases of various subtypes of influenza, including H3N2, have been reported till 9 March across India.
This includes 1,245 cases in January, 1,307 in February, and 486 cases in March (till 9 March). Nearly 50 cases of H3N2 are being reported every week in India.
In Karnataka, a total of 26 cases of Influenza A, of which 16 are H3N2 and 10 are H1N1 cases, have been reported. Young children and the elderly with comorbidities are the most vulnerable groups in the context of seasonal influenza.
How is H3N2 different from Covid-19?
A surge in the number of people falling sick with symptoms of cold, cough, fever, and fatigue — very similar to Covid-19 symptoms — has left many wondering how to differentiate between Covid and influenza.
Answering this question, Randeep said, “Only tests can confirm if it is Covid-19 or influenza. However, testing in large numbers for the latter is difficult. There are not many kits and, also, it would be like testing for the common cold. The test is currently being done only for severe cases with ICU hospitalisation.”
Meanwhile, the Indian Council of Medical Research (ICMR), in a recent release, said that H3N2 is a subtype of the Influenza A virus that can cause respiratory illness in humans. The virus attacks the respiratory system of the body, leading to flu-like symptoms.
Explaining further, Dr Sanjay G, Physician at Shanti Hospital in Bengaluru said, “Seasonal influenzas are of four types — A. B, C and D. H3N2 is a type A influenza virus.
Are symptoms of H3N2 different from Covid-19?
The Karnataka Health Commissioner said that the symptoms of both influenza and SARS-CoV-2 are almost the same. They are both caused by contagious viruses and can spread through droplets. Both viruses mutate and are highly transmissible. However, they belong to different families of viruses.
“They both cause respiratory illnesses. We are monitoring the hospitals to know the hospitalisation status of this illness,” Randeep added. However, it is known that people with comorbidities and the elderly may require hospitalisation in both these cases, he explained.
Influenza A subtype H3N2 is the major cause of current respiratory illness. ICMR-DHR established pan respiratory virus surveillance across 30 VRDLs. Surveillance dashboard is accessible at https://t.co/Rx3eKefgFf@mansukhmandviya @DrBharatippawar @MoHFW_INDIA @DeptHealthRes pic.twitter.com/3ciCgsxFh0
— ICMR (@ICMRDELHI) March 3, 2023
While Covid-19 cases were initially reported with a drop in oxygen stats and may present with or without fever, influenza cases usually report with fever that settles down quickly.
The World Health Organisation recently held a press conference to state that several countries are reporting a surge in influenza cases and the symptoms include fever, vomiting, diarrhoea, chills, coughing, sore throat, nausea, throat ache, body ache, sneezing, and runny nose.
It has been reported that a lingering cough has been one of the major symptoms of influenza.
Meanwhile, the incubation period, which is the period in which one person can infect another with influenza, may be shorter than that period for Covid-19. The infection-to-illness time in the case of influenza is said to be one to four days, while it ranges from two to 14 days in case of Covid-19.
Can Covid-19 and influenza occur together?
Dr Gagandeep Kang, renowned microbiologist from CMC Vellore, told South First that both the viruses are in circulation and there are possibilities of co-infection of H3N2 influenza and Covid-19.
Doctors said that since both viruses have similar symptoms that may last for two to three months and are circulating simultaneously in the community, it would be better to test for Covid-19 first to rule it out and then, if need be, samples can be tested for influenza.
“We have seen very few cases of Covid-19 along with influenza. However, as the number of people testing for Covid-19 has also stopped and influenza is a self-limiting illness, the possibility of patients with both these infections together may be missed,” said Dr Sanjay.
How are states monitoring the situation?
The Union Health Ministry is keeping a close watch on the seasonal influenza situation in various states/UTs through the Integrated Disease Surveillance Programme (IDSP) network on a real-time basis.
Held a meeting to review rising cases of #H3N2 Influenza virus in the country.
Advisory issued to States to be on the alert and closely monitor the situation.
Government of India is working with States & extending support for public health measures to address the situation. pic.twitter.com/hXWWdC4wCy
— Dr Mansukh Mandaviya (@mansukhmandviya) March 10, 2023
The ministry is also tracking and keeping a close watch on morbidity and mortality due to the H3N2 subtype. An advisory from the Union Health Ministry stated that, every year, “India witnesses two peaks of seasonal influenza — one from January to March, and other in the post-monsoon season. The cases arising from seasonal influenza are expected to decline from March end. State surveillance officers are fully geared to meet this public health challenge.”
Meanwhile, all states are expected to monitor Influenza-like Illnesses (ILI) and Severe Acute Respiratory Infections (SARI) presenting in outpatient and inpatient departments of healthcare facilities.
Karnataka, Andhra Pradesh, Tamil Nadu, and Telangana have held high-level meetings with the health ministers and experts of the respective states, and have released advisories to conduct screening camps and also strengthen reporting of H3N2.
Several guidelines, including those who should immediately go to the hospital if any symptoms occur, as well as management of the illness, has been released to public.
Randeep said, “Karnataka has a good reporting system. We have asked all the district health officials, surgeons, and healthcare workers in hospitals to ensure comorbid persons/senior citizens/children below 15 years, if suffering from flu symptoms, be diagnosed early and symptomatic treatment started. High-risk patients would need hospitalisation. Unnecessary over-the-counter use of drugs and self-medication for such patients shall be avoided. Meanwhile, the BBMP has been asked to take up clinical audit of all hospitalised cases to ascertain status.”
Meanwhile, in Andhra Pradesh, which so far has reported 12 cases, said that patients suffering from cough and sneeze must wear masks in public.
Telangana Health Minister Harish Rao held a video conference on the situation in the state on Friday and explained that there has been a slight increase in cases in Telangana and the number of OPD cases with symptoms of fever, cough, and stool pain has increased.
Dos and Don’ts of influenza infection
- Maintain hand hygiene
- Wear masks in public
- If symptomatic, wear a mask
- Cover your mouth while sneezing or coughing in public places
- Stay hydrated
- Take only paracetamol for fever
- Do not self-medicate
- Do not spit in public places
- Do not shake hands