Thursday, October 29, 2009

Avoid Pregnancy during this flu season

The other day immediately after a panel discussion for doctors on 2009 H1N1 flu [Swine flu] conducted by the local branch of Indian Medical Association [in which I was a panelist] a lady doctor came to me with a question.

She introduced herself and informed me that she is 4 month pregnant.

'Is it advisable for me to continue seeing patients?"

For a moment I was not sure what to answer. I had never seen a guideline asking pregnant health care workers to avoid seeing patients during this pandemic of 2009 H1N1.

But when you look at the scientific evidence there is obviously increased risk if a pregnant person get infected with 2009 H1N1 virus.

I answered like this.

"Obviously there is an increased in risk and if there is a possibility that you may have to examine many patients with flu symptoms it is better you avoid such a job.

Then she said she would take leave till her delivery.

Recently the CDC in USA has come out with statistics of pregnant women affected by the new H1N1 flu. It says of the 100 pregnant women who were admitted with severe illness due to 2009 H1N1 flu in USA, 28 died. This is a high rate of mortality. That’s why pregnant women are on the top of the list for eligible candidates for the new influenza vaccine.

In India, in my state of Kerala of the 14 persons who died till date due to H1N1 flu, 3 were pregnant. Statistics are similar in most other parts of the world.

Vaccines may not available for most of the pregnant women in third world countries this winter.

So what is the solution?

If possible avoid pregnancy this flu season.

Thursday, October 15, 2009

Effect of climate change on Health

Today October 15th is the Blog Action Day and this year's theme is climate change.

What are the effects of climate change on health?

Rapidly changing Climate is a major challenge to public health together with poverty, inequity, and infectious and non-communicable diseases. Furthermore, the poorest countries will suffer the greatest consequences of climate change even though they contributed the least for emissions.

Patterns of disease and mortality

Global temperature rise will directly affect health. The heat waves of 2003 in Europe caused up to 70 000 deaths, especially from respiratory and cardiovascular causes. Rising temperatures are likely to generate heat-related stress, increasing the short-term mortality rate due to heatstroke. Regions that are heavily urbanised will be more adversely affected than rural ones.

Rising temperatures will also affect the spread and transmission rates of vector-borne and rodent-borne diseases. Temperature affects rate of pathogen maturation and replication within mosquitoes, the density of insects in a particular area, and increases the likelihood of infection. Therefore, some populations who have little or no immunity to new infections might be at increased risk. Vector reproduction, parasite development cycle, and bite frequency generally rise with temperature; therefore, malaria, tick-borne encephalitis, and dengue fever will become increasingly widespread. In some cases, extreme events, such as heavy rains, will wash away eggs and larvae and decrease vector populations.

Mosquitoes responsible for malaria will grow, by accessing warm high altitudes, in places once free of the disease. It is estimated that 260—320 million more people will be affected by malaria by 2080 as a consequence of new transmission zones.

Dengue fever is sensitive to climate. The disease is prominent in urban areas because of inadequate water storage that affects about 100 million people worldwide. Climate change will increase the number of regions affected by arbovirus, such as Australia and New Zealand. Heavy rainfall and a rise in temperature increase the rate of infection. By 2080, about 6 billion people will be at risk of contracting dengue fever as a consequence of climate change, compared with 3·5 billion people if the climate remained unchanged.

Schistosomiasis, fascioliasis, alveolar echinococcosis, leishmaniasis, Lyme borreliosis, tick-borne encephalitis, and hantavirus infections are all projected to increase as a result of global climate change.

As ocean temperatures rise with global warming and more intense El NiƱos, cholera outbreaks might increase as a result of more plankton blooms providing nutrients for Vibrio cholerae. In 1998, increased rainfall and flooding after hurricane Mitch in Nicaragua, Honduras, and Guatemala caused a leptospirosis outbreak, and an increased number of cases of malaria, dengue fever, and cholera.


Climate change threatens human health through its effect on under nutrition and food insecurity. Chronic and acute child malnutrition, low birth weights, and sub optimal breastfeeding are estimated to cause the deaths of 3·5 million mothers and young children every year. Furthermore, one in three children under the age of 5 years born in developing countries suffer from stunting due to chronic under nutrition. Climate change will compound existing food insecurity.

A study suggests that half of the world's population could face severe food shortages by the end of the century because rising temperatures take their toll on farmers' crops. Harvests of staple food crops, such as rice and maize, could fall between 20% and 40% as a result of increased temperatures during the growing season in tropical and subtropical regions.

Water and Sanitation

Safe and reliable access to clean water and good sanitary conditions are essential for good health. In 2002, 21% of people living in developing countries did not have sustained access to an improved water source, and 51% did not have access to improved sanitation.

Changing rainfall and temperature over the next decades are likely to make provision of clean water, good sanitation, and drainage even more complicated than it is now. Average annual rainfall is forecast to decrease in some regions and increase in others, and droughts and floods are likely to become more frequent and intense. Regional temporal patterns of rainfall might also be altered: the problem is not simply sustained drought, but also severe rainfall all at once followed by less rainfall, thus annual rainfall might rise, but still cause drought.

More than a sixth of the world's population currently live in glacial-fed water catchments, which are vulnerable to climate change. Increasing rates of glacial melting are predicted to lead to great reductions of water availability. In the near future, high peak flows in glacial-fed rivers are expected, as the rate of glacier-mass loss increases, followed by dramatic reductions in river flow and freshwater availability as glaciers progressively disappear. Rising temperatures are also likely to result in earlier snow thawing and increased rain relative to snow precipitation, bringing peak river flows earlier in the year, potentially exacerbating dry season water scarcity.

Reduced river flows and increased water temperature will lead to declining water quality as the dilution of contaminants is reduced, less oxygen is dissolved in water, and microbiological activity increases. These effects could lead to major health problems for vulnerable people, especially during drought, and might increase the risk of conflict and major population migration.


Many of the most serious public health consequences of climate change will be experienced by the world's poorest nations, increasing global health inequities. Basic infrastructure for much of the world's population is inadequate to meet essential health care needs, and our ability to cope effectively with the aftermath of natural disasters is insufficient. Overall, all the underlying social, economic, and ecological determinants of global illness and premature death will be exacerbated by climate change. Progress towards the Millennium Development Goals and achievement of the 2015 targets might be impaired or reversed. Because climate change acts mostly as an amplifier of existing risks to health, poor and disadvantaged people will experience greater increments in disease burden than rich, less vulnerable populations.


Gender inequity is another important factor. In developing countries, women are among the most vulnerable to climate change; they not only account for a large proportion of the agricultural workforce but also have few alternative income opportunities. Women manage households and care for family members, which limit their mobility and increase their vulnerability to natural disasters and other local sudden climate changes. Efforts to keep the adverse effects of climate change to a minimum should ensure that policies address issues of women's empowerment.

Climate change is not just an environmental issue but also a health issue. The ability to adapt to the health effects of climate change depends on measures that reduce its severity—i.e., mitigation measures that will drastically reduce carbon emissions in the short term, but also increasing the planet's capacity to absorb carbon. This is a crucial issue that must be acted upon urgently.

Source: The report of The Lancet Commission on health effects of climate change published in The Lancet dated 16th May 2009.

Thursday, October 8, 2009

Latest update on Novel H1N1 influenza pandemic 2009

Novel H1N1 influenza pandemic [swine flu pandemic] in India is not news anymore. There is no breaking news on TV channels about deaths caused by negligence of doctors. Health Minister is invisible. Newspapers have stopped counting the deaths. Many in India believe that the 'swine flu' is not killing anymore because they are not reading/viewing such news now. But what is the actual situation?

There have been a total number of 11354 confirmed cases of novel H1N1 flu infections in India till October 7th 2009.Of, which 366 persons have died. This is the officially confirmed figure and not an estimate. Many believe that a large number of infections and death may not have been included in the official data. Official statistics show that there have been 147 deaths in Maharashtra and 101 deaths in Karnataka.

The Indian Health authorities who studied the first 82 deaths that occurred till Aug 31 said that maximum deaths occurred in the adult age group.

Among the dead were 43 men and 39 women, including three pregnant women.

Of the first 82 deaths, 61 were in urban areas and 19 in rural areas. There were five deaths in the age group of 0-5 years and three from 6-15 age group. Thirteen victims were from the age group of 16 to 25 years, while 18 people died in the age group of 26-35 years.24 people died in the age group of 36-45, as compared to 18 deaths in the age group of 46-65. Only one person died in the above 65-year category.

Statistics from other countries also show similar age distribution.

Worldwide Brazil [1164 deaths], USA [814 deaths] and Argentina [539 deaths] lead India [366 deaths] in death toll.

It is expected that by the end of this winter India will overtake all other countries in the death toll.

Yet another feather in India's cap?

H1N1 flu vaccine

Vaccine for novel H1N1 flu is available in few countries now.

The groups recommended by CDC in USA to receive the 2009 H1N1 influenza vaccine include:

1.Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;

2.Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants younger than 6 months old might help protect infants by “cocooning” them from the virus;

3.Healthcare and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity;

4.All people from 6 months through 24 years of age

Children from 6 months through 18 years of age because cases of 2009 H1N1 influenza have been seen in children who are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, and
Young adults 19 through 24 years of age because many cases of 2009 H1N1 influenza have been seen in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population; and,

5.Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza

2 shots are recommended for those below 10 years and one shot for others.