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First swine flu death in country
14-year-old girl from Pune dies
Aditi Tandon
Tribune News Service

Doctors also in grip

The country today also reported the first case of swine flu among caregivers, with three doctors (including one female doctor from Ahmedabad) and one nurse testing positive for the virus. They have been put on Tamiflu and their contacts on chemoprophylaxis.

New Delhi, August 3
India today recorded its first swine flu death, with a 14-year-old girl from Pune becoming the first casualty of the deadly Influenza A H1N1 virus, of which the country is witnessing the second wave. The death happened a day after three more persons, including two students, tested positive for the virus, taking the number of infected in the city to 101. Several schools were shut down in Pune, with countrywide infections soaring to 567 today.

In whatís being suspected to be the first case of human-to-human transmission in India, the Pune teenager who died today reported the first symptoms on July 21, with sore throat, runny nose and headache, and saw a general practitioner. With some improvement, she went to school on July 23, only to develop fever and see another private doctor.

The fever did not subside and she was admitted to a private nursing home on July 27 where her condition worsened. She was shifted to the ICU, put on a ventilator on July 29 - the day her lung aspirate was sent to the National Institute of Virology, Pune, for testing. The test confirmed swine flu, and it was on July 30, nine days after the initial symptoms of the infection, that the girl was administered Oseltamivir (Tamiflu).

By then, it was too late (the virus has an incubation period of seven to 10 days) and the girl died of multi-organ failure. She is learnt to have been treated for pneumonia, a wrong diagnosis.

Confirming the death today, Health Minister Ghulam Nabi Azad said the girl could have been saved had she been administered Tamiflu at the right time. He added that the government, by tomorrow, would prepare a fresh strategy to combat the virus. Meanwhile, the health ministry has asked all private hospitals to make swine flu testing mandatory and patients to report at government facilities.

For the government, todayís death comes as huge challenge as it does not seem to be a case of imported infection. So far, the Health Ministry has been maintaining that all Indian cases of influenza A H1N1 virus are imported, with few secondary transmissions in which locals caught the virus from affected people travelling to or coming from abroad.

But the Pune teenagerís appears to be a case of human-to-human transmission, which, in itself, is serious, as it indicates indigenous infection, hitherto not reported in India. The exact cause of death would be known later, with Maharashtra Chief Minister Ashok Chavan today ordering a probe into the childís death at Jehangir hospital in Pune. Her body has been taken for the last rites and serious concerns remain about the condition of children in the school she attended in the interregnum while she was feeling better.

Meanwhile, the first swine flu death, that too in a private facility, raises questions about the government control of Tamiflu stock. Doctors attending to the dead child have already been saying they did not have the drug stock, as the government has kept the supply within public system to avoid the misuse of drug that could help the virus develop resistance.

Even though the government has reiterated that patients should visit government hospitals, it may not be in a position to ensure everyone does that, which means it may have to reconsider government supply of Tamiflu, the only known treatment of swine flu. The government has asked people not to panic.

Meanwhile, there has been an outbreak of fever in a hostel in a private school at Panchgani, Satara (Maharashtra), 90 children reporting swine flu like symptoms; 27 of them had travelled to the USA to visit NASA and 10 had visited Holland in April, May. Ten of the 34 samples collected from them have tested positive for Swine flu. Out of 127 samples collected from six other schools in the area, 23 have tested positive. The situation is being monitored.

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