A persistent cough, sometimes accompanied by fever, running through India for the past two-three months is due to Influenza A subtype H3N2.
The H3N2, which has been in wide circulation for the past two-three months, causes more hospitalizations than other subtypes, said Indian Council of Medical Research (ICMR) scientists who keep a close watch on ailments caused by respiratory viruses through the Virus Research and Diagnostic Laboratories network.
They have also suggested a list of Dos and Don’ts for people to follow to protect themselves from contracting the virus.
The Indian Medical Association (IMA) has advised against the indiscriminate use of antibiotics amid rising cases of cough, cold, and nausea across India. Seasonal fever will last five to seven days, it said.
The fever goes away at the end of three days but the cough can persist for up to three weeks, the IMA’s Standing Committee for Anti-Microbial Resistance said.
Viral cases have also surged due to air pollution, it said, adding that it mostly occurs in people aged below 15 and above 50 and causes upper respiratory infections along with fever. They ask doctors to prescribe only symptomatic treatment and not antibiotics.
“Right now, people start taking antibiotics like Azithromycin and Amoxiclav, etc, that too without caring for done and frequency and stop it once start feeling better. This needs to be stopped as it leads to antibiotic resistance. Whenever there will be a real use of antibiotics, they will not work due to the resistance,” the IMA said in a statement.
The most misused antibiotics are Amoxicillin, Norfloxacin, Ciprofloxacin, Ofloxacin, and Levofloxacin. These are being used for the treatment of diarrhea and UTI, it said.
“We have already seen widespread use of Azithromycin and Ivermectin during Covid and this too has led to resistance. It is necessary to diagnose whether the infection is bacterial or not before prescribing antibiotics,” it said.
Prevention
Apart from antiviral treatment, public health management includes personal protective measures like:
Regular hand washing with proper drying of the hands
Good respiratory hygiene – covering mouth and nose when coughing or sneezing, using tissues, and disposing of them correctly
Early self-isolation of those feeling unwell, feverish, and having other symptoms of influenza
Avoiding close contact with sick people
Avoiding touching one’s eyes, nose, or mouth
Symptoms
Symptoms of H3N2v infection are similar to those of seasonal flu viruses and can include fever and respiratory symptoms, such as cough and runny nose, and possibly other symptoms, such as body aches, nausea, vomiting, or diarrhea.
Common initial symptoms are high fever (greater than or equal to 38°C) and cough followed by symptoms of lower respiratory tract involvement including dyspnoea or difficulty breathing. Upper respiratory tract symptoms such as the sore throat or coryza are less common.
Other symptoms such as diarrhea, vomiting, abdominal pain, bleeding from the nose or gums, encephalitis, and chest pain have also been reported in the clinical course of some patients. Complications of infection include severe pneumonia, hypoxemic respiratory failure, multi-organ dysfunction, septic shock, and secondary bacterial and fungal infections. The case fatality rate for A(H5) and A(H7N9) subtype virus infections among humans are much higher than that of seasonal influenza infections.
For human infections with avian influenza A(H7N7) and A(H9N2) viruses, the disease is typically mild or subclinical. Only one fatal A(H7N7) human infection has been reported in the Netherlands so far. For human infections with swine influenza viruses, most cases have been mild with a few cases hospitalized and very few reports of deaths resulting from infection.
Treatment
Evidence suggests that some antiviral drugs, notably neuraminidase inhibitors (oseltamivir, zanamivir), can reduce the duration of viral replication and improve prospects of survival, however, ongoing clinical studies are needed. The emergence of oseltamivir resistance has been reported.
In suspected and confirmed cases, neuraminidase inhibitors should be prescribed as soon as possible (ideally, within 48 hours following symptom onset) to maximize therapeutic benefits. However, given the significant mortality currently associated with A(H5) and A(H7N9) subtype virus infections and evidence of prolonged viral replication in these diseases, administration of the drug should also be considered in patients presenting later in the course of illness.
Treatment is recommended for a minimum of 5 days but can be extended until there is satisfactory clinical improvement. Corticosteroids should not be used unless indicated for other reasons (eg: asthma and other specific conditions); as it has been associated with prolonged viral clearance, and immunosuppression leading to bacterial or fungal superinfection.
The most recent A(H5) and A(H7N9) viruses are resistant to adamantane antiviral drugs (e.g. amantadine and rimantadine) and are therefore not recommended for monotherapy.
The presence of co-infection with bacterial pathogens can be encountered in critically ill patients.
