Second deadlier wave of H1N1 imminent: Experts

Warning of a second wave of the H1N1 pandemic that might be highly pathogenic and have a high fatality rate, experts have asked the government to be prepared to face any eventuality.

"A second wave of pandemic is likely to occur. The virus may acquire higher pathogenicity and increased case fatality," scientists at the Christian Medical College Vellore have said in a report.

They added that the strain may also become resistant to antiviral drugs.

With the arrival of the delayed south-west monsoon rainy season, the virus is likely to spread -- and may subsequently continue as endemic influenza for an unpredictable duration, the report published in the latest edition of the Indian Council for Medical Research journal says.

"India must also be prepared for other eventualities," it warns.

According to the scientists, the ministry of health should be aware of any such possibility so that plans could be made now to face each of the above eventualities.

The scientists noted that India does not have a public health infrastructure that could put into practice the Pandemic Preparedness and Response Plan.

"Therefore, ad hoc and make shift plans were made and implemented in urban communities to fit the available healthcare facilities, ignoring the majority rural population," the scientists said.

Steps should also be taken by the government to establish public health infrastructure for long term benefits and equity in healthcare services, the scientists said.

Soon after the pandemic declaration by the World Health Organisation, India began checking passengers arriving at international airports for symptoms of influenza and for testing for H1N1.

This process, although well known to be insufficient to stop the entry of the virus and spread within the country, gave an additional 2-3 weeks of time to slow down the spread which should have been sufficient to rapidly activate the PPRP for systematic interventions.

According to the earlier version of PPRP, a Crisis Management Committee and a Pandemic Intervention Committee were to be established as soon as the threat was perceived to be at our doorsteps.

The experts said that the government had formulated a pandemic preparedness plan following a WHO advisory which failed after the H1N1 outbreak as India does not have sufficient health infrastructure to implement it.

The expectation was that influenza PPRP could be implemented through the National Institute of Communicable Diseases under the Department of Health Services of the ministry of health and family welfare supported by the Indian Council of Medical Research.